Anterior talofibular ligament injury - rupture with soft-tissue impingement

Case contributed by Tim Luijkx


Conservatively treated ankle fracture 7 months prior. Anterior talofibular ligament injury?

Patient Data

Age: 40 years
Gender: Male

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

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 hypointense 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.

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.

yellow arrows: ruptured ATFL
red arrows: ruptured anterior syndesmosis with fibrosis
green arrows: fluid signal suggestive of soft-tissue impingement associated with ATFL rupture

Case Discussion

Key findings:

  • subtotal ATFL rupture with signs of active soft-tissue impingement
  • previous anterior syndesmosis injury, healed with fibrosis
  • focal thickening of the anterior tibiotalar joint capsule with signs of active impingement
  • Achilles tendon peritendinitis

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