Department of Radiology, Hôpital Saint-Antoine, Sorbonne University, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France.
Eur Radiol. 2019 Nov;29(11):6336-6344. doi: 10.1007/s00330-019-06156-1. Epub 2019 Apr 1.
To test the hypothesis if presence and amount of effusion in the tibiotalar and talocalcaneal joints are associated with an increased risk for severe structural injury in ankle sprains.
A total of 261 athletes sustaining acute ankle sprains were assessed on MRI for the presence and the amount of joint effusion in the tibiotalar and talocalcaneal joints, as well as for ligamentous and osteochondral injury. Specific patterns of injury severity were defined based on lateral collateral ligament, syndesmotic, and talar osteochondral involvement. The presence and the amount effusion (grades 1 and 2) were considered as risk factors for severe injury, while physiological amount of fluid (grade 0) was considered as the referent. Conditional logistic regression was used to assess the risk for associated severe injuries (syndesmotic ligament rupture and talar osteochondral lesions) based on the presence and amount of tibiotalar and talocalcaneal effusions.
For ankles exhibiting large (grade 2) effusion in the tibiotalar joint (without concomitant grade 2 effusion in the talocalcaneal joint), the risk for partial or complete syndesmotic ligament rupture was increased more than eightfold (adjusted odds ratio 8.7 (95% confidence intervals 3.7-20.7); p < 0.001). The presence of any degree of effusion in any of the joints was associated with an increased risk for severe talar osteochondral involvement (several odds ratio values reported; p < 0.001), including large subchondral contusions and any acute osteochondral lesion.
The presence of tibiotalar and talocalcaneal effusions is associated with an increased risk for severe concomitant structural injury in acute ankle sprains.
• For ankles exhibiting severe (grade 2) effusion in the tibiotalar joint after sprain, the risk for partial or complete syndesmotic ligament rupture increases more than eightfold. • The presence of effusion in both tibiotalar and talocalcaneal joints is associated with an increased risk for severe ligament injury such as complete ATFL rupture as well as partial or complete syndesmotic ligament rupture. • The presence of effusion in the tibiotalar or talocalcaneal joints after sprain is associated with an increased risk for severe talar osteochondral involvement.
检验假设，如果距骨下胫腓联合和距下关节存在和量的关节积液与踝关节扭伤后严重结构损伤的风险增加有关。
共评估了 261 名急性踝关节扭伤的运动员，通过 MRI 评估距骨下胫腓和距下关节的关节积液的存在和量，以及韧带和软骨骨损伤。根据外侧副韧带、下胫腓联合和距骨软骨骨受累的特定损伤严重程度模式进行定义。将关节积液的存在和量（1 级和 2 级）视为严重损伤的危险因素，而将生理量的液体（0 级）视为参照。条件逻辑回归用于评估基于距骨下胫腓和距下关节积液的存在和量的相关严重损伤（下胫腓联合韧带断裂和距骨软骨骨病变）的风险。
对于下胫腓关节存在大量（2 级）关节积液（同时无距下关节 2 级关节积液）的踝关节，部分或完全下胫腓联合韧带断裂的风险增加了八倍以上（调整后的优势比 8.7（95%置信区间 3.7-20.7）；p<0.001）。任何关节存在任何程度的关节积液都与严重距骨软骨骨受累的风险增加相关（报道了多个比值比值；p<0.001），包括骨下软骨挫伤和任何急性软骨骨病变。
距骨下胫腓和距下关节积液的存在与急性踝关节扭伤后严重的同时发生的结构损伤的风险增加有关。
踝关节扭伤后出现严重（2 级）下胫腓关节积液时，部分或完全下胫腓联合韧带断裂的风险增加超过八倍。
下胫腓和距下关节均存在积液与严重的韧带损伤相关，如完全前距腓韧带断裂以及部分或完全下胫腓联合韧带断裂。
踝关节扭伤后下胫腓或距下关节存在积液与严重的距骨软骨骨受累风险增加相关。
