0:00

Here we had a 15 year old female with left ankle pain since volleyball

0:05

injuries. So young patient who has had a sports injury.

0:09

So I just wanted to see if I can see those ligaments. So this is your, uh,

0:13

tio tailor will be the deep deloid. See, this is the,

0:16

this is tibials posterior deep to it. This is your spring,

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and the band that comes from the tibia to the spring is your tibia spring.

0:23

So here, deltoid ligaments abnormal, there is increased signal.

0:26

There is marrow edema at its attachment site,

0:28

but I don't see any discontinuity of the fiber,

0:31

so I'll call this as a deltoid ligaments sprain. Okay,

0:34

other things on this case, uh, echoes tendon.

0:37

There is trace fluid in the retrocalcaneal bursa.

0:40

Little intermediate signal here.

0:44

And that's a gradient sequence. Let's make sure, um,

0:51

yeah, a little bit of tendinosis, but other than that, nothing major. Uh,

0:56

plantar fascia looks okay.

1:01

Now moving on to the ankle ligaments, starting from tibian fibula.

1:04

I'll move on to the axial images. This is my,

1:09

uh, syndesmotic area, so there shouldn't be any widening here.

1:13

Not too much of fluid. Little bit of fluid is fine.

1:16

And I come to the fibia fibular ligaments. Again,

1:19

I can check them on axial images.

1:20

So this is where my interior tip fibs looks intact,

1:25

though there is a lot of edema there. Um, this is posterior tip fib,

1:30

uh, looks okay as I move down further,

1:36

come to the level of the ular fossa.

1:38

This is where I expect the anterior and posterior talo fibrile ligaments to be.

1:42

I do see the posterior tail of fibrile ligament,

1:45

but the anterior talo fibular ligament is missing.

1:47

There's a lot of joint effusion, more localized fluid int laterally.

1:51

So these are all your like, and I don't see the, the, the band at all.

1:55

So this will be a complete acute tear of the anterior talo fibular ligament.

1:59

That's one of the most common, um,

2:02

lateral ankle ligaments to be injured. And all this fluid, uh,

2:06

it's an acute injury. It's bright on T two. It has some brightness on T one.

2:10

So there is a, that's why on the report we called it as a hematoma formation.

2:15

Okay, so, um, complete, um,

2:19

anterior talo fibrillin ligament there with hematoma,

2:22

there's increased signal along paf,

2:24

so some sprain of the posterior talo fibrile ligament.

2:27

And let's look at the calca fibula. So this is where the calca fibula is.

2:31

It's it's bright signal,

2:36

but again, I could trace the fiber. So again, um,

2:40

I would just call it as a sprain of calca fibula. Um,

2:45

so those are the lateral ankle ligaments. We already looked at the deloid,

2:48

which again looked like a sprain, not a tear.

2:54

The spring ligament looks okay. Yeah, this is the,

2:58

the rest of the spring ligament.

3:00

Moving on to the axial images for the plantar components of the

3:05

spring ligament. And this is where they are. So they look okay.

3:12

Then moving on to the tendons, the median re reflector tendons,

3:17

little bit of edema, a bit of fluid,

3:19

but that can be reactive because there's so much going on with the ankle.

3:22

So you can get a little bit of fluid,

3:24

but doesn't look like flore tenovus of any of the tendons.

3:27

The extensive tendons are fine. And now we are seeing a lot of, um, bone, um,

3:32

changes too. There are a lot of areas of bone marrow edema.

3:35

So we need to carefully look at it because we have had a, uh,

3:38

we've already found a complete anterior tibular ligament hair.

3:43

And then this has been marked with a arrow here,

3:45

but you see that fracture line edema on T two and you see the nice fracture

3:50

line, uh, on T one weighted images. So we are here,

3:53

we have a non-displaced lateral ular fracture, and it's, uh, it's the epiphysis,

3:58

but if we don't talk in terms of epiphysis, what we talk of,

4:01

whether it's at the level of syndesmosis above the syndesmosis or below the

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syndesmosis. So ankle injuries. When you have these twisting injuries, we,

4:10

if there's a fracture, uh, we, we try to put it in the Weber classification. Uh,

4:14

and any infrared, uh, uh, syndesmotic fracture is a Weber a injury.

4:18

So this will be a Weber a injury.

4:21

Let's see if we see any other displaced fractures,

4:26

just some signal.

4:33

And then we have, um,

4:35

ly bright signal along the anterior aspect of the distal tibial ular surface.

4:41

Focal hypo intensity looks like an, like a focal impaction injury.

4:47

Then there is lot of, uh, marrow change in the tails,

4:52

which is bright. Um, dark signal on on T one weighted images.

4:57

So this would be a MicroTAC injury in the tails.

5:05

And you have similar signal in the oid.

5:08

So there's another microtrabecular injury in the, in the OID as well.

5:18

Let's see what this is. Some more areas of marrow contusions,

5:26

but the joints otherwise look okay.

5:27

I didn't see any evidence of any cartilage loss anywhere.

5:30

The posterior joint looks okay. The tibio Taylor joint looked okay.

5:35

Interior process of calcaneus in that, that's where we see it.

5:44

The tarsal tunnel was okay, sinus tarsa, you have reactive edema,

5:48

but the ligaments are okay. Yeah. So this would be more of a ankle injury,

5:53

whether we, we have an intra syndesmotic,

5:56

Lateral Mylar fracture. We have, um, uh,

6:00

mar contusions in the anterior tibia tails cuboid. Um,

6:05

and then, um, we have, um,

6:09

complete air of the anterior talo fibular ligament with hematoma formation,

6:12

sprain of the posterior fibular calcan, fibular deltoid.

6:20

Yeah. So those, those will be the main findings of, um, in this case.

6:25

So here, I mean, uh, when you have these, um,

6:28

like extensive areas of marrow edema, we need to make sure, um, look for a,

6:33

if there's a fracture line or not. Fractures change management, uh,

6:37

contusions versus fractures. It's, uh, changes the management.

6:42

So we have to look at that. And, and also for ligaments and sports injury,

6:47

looking at the tibia,

6:49

fibular ligaments is important because any injury to the tibial fibular

6:53

ligaments and then high ankle sprain, uh, which is more clinically significant,

6:57

uh, it has, uh, a longer recovery time and if not treated appropriately,

7:02

can lead to long-term ankle instability.

7:05

And injury to the lateral ankle ligaments is common. Uh,

7:09

we see it on like a lot of ankle R exams is a very common

7:14

finding. And anytime you have lateral sided injury,

7:17

you have to make sure the median sided structures are okay because ankle

7:20

injuries are often twisting injury. They're in a form of an arc.

7:23

So one side is involved,

7:25

you have to make sure there's no injury on the other side.

7:27

So those were the key key findings in this case.