Presentation
History of multiple ankle sprains. Clinically feeling of 'giving way' while walking, painful lateral ankle.
Patient Data
Jone effusion is present, with some synovial proliferation. Synovial irregularities in the posterior ankle recess (may also represent very small free bodies). An incongruency between the lateral talus and the distal fibula is noticeable, with anterior translation of the talus. No normal ATFL can be seen, instead, there are irregular soft tissue changes visible in this location. CFL looks attenuated, suggesting a high-grade partial tear/healing of a tear. The tibiofibular syndesmosis is intact. Osteochondral injury (grade IIA) of the lateral talar dome and posteromedial and anteromedial distal tibial plafond. Normal appearance of the sinus tarsi. Some fluid locally in the tendon sheaths of the ankle flexors. The tendons are intact. Marked osteophyte of the neck of the talus and, to a lesser degree, of the anterior tibial margin.
Incidental finding of os trigonum, type 3 accessory navicular bone and peroneus quartus muscle.
Case Discussion
A long-standing ATFL tear can eventually lead to chronic ankle instability. Subsequent incongruency resulted here in osteochondral injuries of the tibiotalar joint and osteophytes formation anteriorly, predisposing for anterior ankle impingement.