MRI features of tendinosis include fusiform thickening and intermediate signal intensity of the tendon on T1W and PD images, and hyperintense signal on T2W image that becomes more extensive with progressive degeneration. This can be challenging, because the actual tear cannot be seen, only the architectural deformation. The various components of the deltoid ligament are well visualized on both axial and coronal images. In this article a systematic approach is presented on how to describe a standard MRI of the ankle. On the fatsat images edema is present in the os trigonum and surrounding soft tissue. This patient has an unfused prominent lateral tubercle with a fibrous connection to the talus, therefore it is a partly fused os trigonum. Use the Mouse to Scroll or the arrows. Ankle Tendons – An Update, Dr. Yvonne Y. Cheung (8-5-20) Rewind 10 seconds MRI Online is a premium online continuing education resource for practicing radiologists ... MRI Online is a premium online continuing education resource for practicing radiologists to expand their … (A) Axial STIR image shows full-thickness tear of anterior talofibular ligament (arrow). The plantar fascia is a connective tissue structure that arises from the inferior aspect of the calcaneus and runs along the plantar aspect of the foot to blend with the deep fascia and transverse ligaments at the level of the metatarsal heads. On MRI, ligaments are best evaluated on fluid-sensitive sequences such as T2 and STIR. On MRI, ligaments are best evaluated on fluid-sensitive sequences such as T2 and STIR. Finally, when fluid flows underneath the defect, the OCD can become unstable and may result in a corpus liberum. Longitudinal intrasubstance tendon tears may be difficult to distinguish from tendinosis and severe tendon degeneration. Extensor tendon pathology at the ankle joint is less frequently reported in the medical literature than diseases of other ankle tendons, but is not uncommon in clinical practice. Isolated injury of the CFL is uncommon. Sometimes the fracture line is not seen on MR. In A there is edema and thickening around the anterior and posterior syndesmosis (arrow), indicative of acute grade 2 injuries. Isolated injury is very rare. The CFL passes two joints, the talocrural joint and the talocalcaneal joint. When compared with surgery, ultrasound has been shown to be both sensitive and specific for detecting tendon tears [ 50 ], differentiating partial- from full-thickness tears in the Achilles tendon [ 99 ], and for detecting tears of the peroneal tendons [ 100 ]. 16-2). They are usually asymptomatic, but can be a cause of impingement in specific patient groups (dancers, athletes). (A) Sagittal STIR image shows the low-signal normal plantar fascia and the calcaneal insertion (arrowheads). The extensor tendons are rarely injured. (B) Coronal STIR image shows normal, low-signal calcaneofibular ligament (CFL) (arrow). This patient has secundary degenerative changes in the joint with subchondral edema and cyst formation. This process can evolve into cyst formation. The muscles of the leg, foot, and ankle are anchored to the bone by tendons, which are strong, cord-like structures. This tendon is best visualized on axial and sagittal MRI. This means that when the CFL or the PTFL are injured, it is very likely that the ATFL is injured aswell. M = medial, L = lateral, A = anterior, P = posterior. The peroneus brevis muscle originates from the distal fibula and interosseous membrane, deep to the peroneus longus. PD). Anatomic classification of lateral ligament tear is based on the number of ligaments involved. Split tears of the peroneus longus are less common. The capsule thickening can be posttraumatic or postoperative. MR findings in tendinopathy are: Thickening Abnormal signal Tenosynovial fluid The lateral (peroneal) tendons include the peroneus brevis medially and the peroneus longus tendon laterally (Figure 18-1A,D). Other imaging findings associated with insertional tendinopathy are calcaneal marrow edema, Haglund deformity (enlarged posterosuperior calcaneal tubercle), and retrocalcaneal and retroachilles bursitis.1. The Achilles tendon is low signal on T2W images; however, the signal intensity is often slightly heterogeneous on T1W and PD images, and it is quite heterogeneous at its insertion.2,3 Sagittal and axial images are the most useful in assessment of the Achilles tendon (Figure 18-1A,B). The peroneus longus tendon migrates forward into the peroneus brevis tendon tear, thereby preventing healing (figure). The right image shows massive joint effusion as a reaction to degenerative osteochondral defects in the tibiotalar joint. Fluid within the peroneal tendon sheath can be a secondary sign of CFL injury.1,5,6, The anteroinferior and posteroinferior tibiofibular ligaments and the interosseous membrane are most commonly injured in external rotation and hyperdorsiflexion. People with peroneal tendinosis typically have tried a new exercise or markedly increased their activities. The CFL is frequently seen as a band of low-signal-intensity parallel to the lateral wall of calcaneus on axial MRI. They are associated with a prominent calcaneal tubercle. Marrow edema of the lateral calcaneus and peroneal tubercle may also be noted. In B there is edema and thickening of the posterior syndesmosis, which is an acute grade 2 injury. With chronic tenosynovitis, focal or diffuse thickening of the tendon and scarring of peritenon is noted. Anyone can suffer from a sprain, and athletes often experience sprains due to the repetitive nature of … On the non fatsat images however, there is obvious thickened fibrotic tissue on the anterior side. The spring ligament consists of three components: the superomedial calcaneonavicular ligament, the medioplantar oblique calcaneonavicular ligament, and the inferoplantar longitudinal calcaneonavicular ligament.4, There are four groups of tendons around the ankle: anterior, posterior, medial, and lateral. This type of ache can have a… The medial collateral ligament complex is divided into superficial and deep layers. The superomedial calcaneonavicular ligament is the most often injured component of the spring calcaneonavicular complex. Once you have studied the bones, scan the joints for effusion. Compression of the os trigonum and surrounding soft tissues between the tibia and the calcaneus during plantar flexion can be a cause of posterior impingement. Calcaneal fractures predispose the peroneal tendons to partial tears, dislocation, or entrapment. Characteristic activities include marathon running or others that require repetitive use of the ankle. Tendons: check the tendons using the four quadrant approach; Flexors on the medial side. Type III tear is rare and shows complete discontinuity of the tendon. MRI findings of acute tenosynovitis include fluid within tendon sheath with normal shape and signal of the tendon. Tendon pathology. Grade III injury is a complete disruption of the ligament with marked surrounding edema. Patients usually have pain around the back and outside of the ankle. Dislocation of posterior tibial tendon is rare, seen in young patients following ankle injury, leading to tear of flexor retinaculum and tendon dislocation. This patient has edema in the calcaneus as a result of a stress fracture. On the axial image, the edema is localised around the insertion site of the posterior syndesmosis. First look at the images. At the same level, the PTFL may be seen. (D) Coronal STIR image in different patient shows partial thickness tear of tibiotalar fibers (deep layer) of the deltoid ligament (arrow). In C there is scar tissue as a result of previous injury, which again can be a cause of posterior impingement. Figure 18-2. (a) Sagittal STIR MR image of the ankle shows a ruptured PL tendon retracted to the level of the lateral malleolus (arrowhead) and a longitudinal split tear of the PB tendon (arrows). The effusion can run alongside the flexor hallucis longus tendon (FHL), since this tendon sheath is continuous with the joint. There is significant overlap in the imaging appearance of asymptomatic tendon degeneration and symptomatic tendinopathy; therefore, MRI changes of the tendon alone cannot reliably predict a clinically significant lesion.1,3, Partial tendon tear shows heterogeneous signal intensity similar to advanced tendinosis in all MRI sequences, without complete interruption.