Anterior talofibular ligament injury (ATFL) rupture with soft-tissue impingement

Case contributed by Dr Tim Luijkx

Presentation

Conservatively treated ankle fracture 7 months prior. ATFL injury?

Patient Data

Age: 40
Gender: Male

Bone and joints:
No bone marrow oedema. Tibiotalar joint effusion.
Fracture line through fibula still recognisable, anteriorly not fully consolidated.

Ligaments:
Intact deltoid ligament, calcaneofibular ligament (CFL), posterior talofibular ligament (PTFL) and posterior syndesmosis (posterior tibiofibular ligament).
Thickened hypointense tissue where the anterior syndesmosis (anterior tibiofibular ligament) is expected, in keeping with rupture and subsequent fibrosis.
Thickened hyperintense tissue where the anterior talofibular ligament (ATFL) is expected with high signal on fat-suppressed images, suggestive of ATFL rupture with soft-tissue impingement.

There is a focal linear hypo intense structure on the anterior aspect of the tibia, possibly focal thickening of the joint capsule. This is surrounded by fluid signal suggestive of soft-tissue impingement as well.

Tendons:
Hyperintense signal in the achilles tendon near its insertion on the calcaneus and fluid surrounding the tendon in keeping with peritendinitis.

Soft tissues:
Subcutaneous edema medially and laterally.

Case Discussion

1. Subtotal ATFL rupture with signs of active soft-tissue impingement
2. Previous anterior syndesmosis injury, healed with fibrosis 
3. Focal thickening of the anterior tibiotalar joint capsule with signs of active impingement
4. Achilled tendon peritendinitis

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Case information

rID: 38765
Case created: 2nd Aug 2015
Last edited: 20th Sep 2016
Inclusion in quiz mode: Included

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