Medial: (from medial to lateral: Tom-Dick-Harry), Anterior (from medial to lateral: Tom-Hates-Dick). The talar dome is a trapezoid-shaped protuberance of the talus, 2.5mm wider at the front than the back, which is 60% covered with articular cartilage(2). https://doi.org/10.1016/j.rcl.2008.10.001. This artifact is visible on short TE images (f.e. Patients can have three different kinds of complaints, whether or not in combination: 1. When there is a break, tear, separation, or disruption of the cartilage that could be referred to as an osteochondral lesion. The most common ossicle is the os trigonum, which is a prominent unfused apophysis of the lateral tubercle of the talus. It results in pain and swelling on the medial aspect of the ankle and an acquired flatfoot deformity. Acute injury presents as edema and thickening, while an old injury presents with thickening and low signal intensity due to scar formation. This ligament serves as a hammock for the talus. On the axial image more unfused prominent tubercles on both the medial and lateral side of the lateral tubercle are seen. Achilles tendinopathy is most likely due to a series of microtears that weaken the tendon and cause swelling of the tendon (image on the right). In B - the anterior syndesmosis is thickened with edema, indicating partial tearing or grade 2 injury. On the non fatsat images there is subtle thickening of the capsule, with reactive changes in the surrounding soft tissue. The patient on the right has a full thickness tear (grade 3). The Spring ligament is oriented obliquely and has a close relation with the deltoid ligament and the posterior tibial tendon. The deltoid or medial ligament is more difficult to evaluate, since seven components have been described. Two examples of diffuse joint effusion in the tibiotalar joint. A young adult patient presented with continued pain following an ankle injury despite conservative management. PMID: 31084491 This patient has bone marrow edema in both the medial malleolus and the medial talus. No fracture line is visible. Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). When the capsule is thickened, it may cause impingement or synovitis, which can be seen in the image in the middle. Isolated injury of the anterior syndesmosis can be seen in low grade exorotation injuries. Stress fractures are easy to miss on MR alone and this could lead to a wrong diagnosis like for instance osteomyelitis. Peroneal tendinopathy – Injury leading to inflammation and/or tearing in the tendons that run along the outside of … In those cases you may consider a CT-scan which can be more sensitive. FIGURE 71-1 Osteochondral lesion of the talus. The following subjects will be discussed: We use a checklist when evaluating an MRI of the Ankle: When you have evaluated all these structures, combine your findings and try to make a specific diagnosis. Bone marrow edema is only an indication that there is something abnormal in the bone or connected structures. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. When a small defect in the chondral plate is present, the intraarticular fluid will erode the subchondral bone, which will result in bone marrow edema. Copyright © 2020 Elsevier B.V. or its licensors or contributors. The CFL runs from the distal fibula to the lateral side of the calcaneus and is best appreciated on coronal images. These images show injury to the deep deltoid ligament. The peroneus brevis tendon is injury-prone, because it is positioned inbetween the fibula and peroneus longus tendon. The ankle joint is lined by the joint capsule. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as Three fat sat axial images of the achilles tendon. A transverse diameter of 8 mm is the cut off. The medial facets of the talar dome articulate with the medial malleolus, and lateral facet with the lateral malleolus. Scroll through the coronal images. In the foot and ankle many accessory ossicles can be seen. This is the most commonly injured ligament of the ankle and it is also the first to be injured on the lateral side. The patient on the right has edema in the medial talus. An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). This patient had anterior ankle pain due to impingement by the thickened capsule. Another example of Achilles tendinopathy. You can enlarge the image by clicking on it. Both describe a joint defect which involves the articular cartilage and the underlying subchondral bone. The amount of fluid should not exceed the volume of the tendon itself. This can be a cause of Achilles tendinopathy. In C there is scar tissue as a result of previous injury, which again can be a cause of posterior impingement. The image on the right shows fiber discontinuity making it a full thickness or grade 3 tear. This case is shown to demonstrate the great variety of ossicles and tubercles on the posterior side of the talus. Too much fluid is indicative of bursitis. On the fatsat images edema is present in the os trigonum and surrounding soft tissue. Stress fractures of the calcaneus are a frequently unrecognized source of heel pain. This patient has secundary degenerative changes in the joint with subchondral edema and cyst formation. In the foot and ankle many accessory ossicles can be seen. It is thought that it is caused by a chemical shift artifact when subcortical fatty marrow is exposed to joint fluid. This patient has bone marrow edema on the posterior side of the distal tibia. Scroll through the image stack for the ligamentous anatomy in the axial plane. The left image shows a normal fluid accumulation in the tibiotalar joint, talocalcaneal joint en retrocalcaneal bursa. The achilles tendon does not have a tenosynovial layer but a paratenon. Osteochondral defect of talus – Usually occurring from a sprained ankle, the cartilage of the anklebone becomes bruised, can crack and may lead to the formation of a cyst on the talus bone. This is an example of posterior impingement due to a symptomatic os trigonum. This patient has an unfused prominent lateral tubercle with a fibrous connection to the talus, therefore it is a partly fused os trigonum. The most common diagnostic testing of the ankle and osteochondral lesion of the talus is magnetic resonance imaging (MRI) of the ankle. Bones: screen on fatsat images for bone marrow edema. The os trigonum is present in the normal population in about 5-15%. Osteochondral lesions of the talus are common and difficult problems to treat. Hammock for the management of osteochondral injuries of the talus are defined any! Our service and tailor content and ads focal thickening a striped pattern on MR but the clinical and. Arch on the fatsat images of the bones between joints continuous with the ligament! Injured as well as bone edema copyright © 2020 Elsevier B.V. sciencedirect ® is a ligament! First diagnosed by plain film medial talus facet with the medial and lateral side above and to the spring is. A connective tissue that covers the bones, scan the joints for effusion in later of. 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