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L Foot, Ankle Sprain

2013-08-25 – ?

Grade: 4

MRI results:

Clinical history: Injury in August with normal x-ray. Persistent pain and stiffness.
Technique: Multiplanar and multisequence MRI of the left ankle performed utilising sagittal PD, sagittal PD fat-sat, axial PD, axial PD fat-sat and corona! PD sequences.
Findings: There is high grade injury to the ATFL with torn deep fibres, the remainder of ATFL is thickened and heterogeneous, consistent with ongoing attempt of scar formation. The CFL is thickened and with heterogeneous signal, consistent with subacute intermediate to high-grade partial injury and ongoing attempt of scar formation. There is a small ganglion, immediately inferior to the PTFL measuring 8mnn, suggestive low-grade partial injury to the PTFL.
The AITFL and PITFL appear intact. The deltoid ligament is abnormal. The deep fibres of the deltoid ligament is heterogeneous, with increased signal, suggestive of subacute intermediate to high-grade partial injury. The anterior tibiotalar, tibiospring, and tibionavicular portions of the deltoid ligament appear intact. The spring ligament complex and interosseous talocalcaneal ligaments are intact. The Lisfranc's ligament complex is not well seen.
No significant bone marrow oedema is demonstrated. There is moderate to large ankle joint effusion. No peroneus tenosynovitis evident. Trace of fluid around the distal tibialis posterior tendon is suggestive of mild tenosynovitis. The flexor digitorum, flexor hallucis longus, extensor digitorum longus, extensor hallucis longus and tibialis anterior tendons are intact and unremarkable. Talar dome is intact without osteochondral abnormality or significant cartilage wearing demonstrated.
Achilles tendon and plantar fascia are intact. No compression of tarsal tunnel structures.
CONCLUSION: High-grade partial injury to the ATFL, CFL and deep fibres of deltoid ligament, with ongoing attempted scar formation. No meniscoid lesion demonstrated.
There is also low-grade partial injury of the PTFL with adjacent ganglion formation. Large ankle joint effusion.