Patients with acute inversion-type ankle sprain were divided into three equal groups based on MRI timing: hyperacute (0–7 days), subacute (8–21 days), and late (>21 days).
Abstract
Background: This study aimed to investigate the impact of magnetic resonance imaging (MRI) timing on radiological findings and diagnostic interpretability in patients with acute lateral ankle sprain. Methods: In this retrospective observational cohort study, 75 adult patients with acute inversion-type ankle sprain were divided into three equal groups based on MRI timing: hyperacute (0–7 days), subacute (8–21 days), and late (>21 days). All MRIs were performed using a 3.0T scanner and evaluated by a blinded musculoskeletal radiologist. Ligament integrity, bone marrow edema, joint effusion, and soft tissue edema were assessed, along with a 3-point diagnostic interpretability scale. Multivariate analyses adjusted for age, sex, and clinical severity.Results: ATFL tear classification differed significantly across groups (p
INTRODUCTION
Ankle sprains are among the most common musculoskeletal injuries, yet their clinical complexity is often underestimated. The relationship between ankle sprains and bone bruises in both the ankle joint and midfoot remains underexplored. At our institution, patients with moderate to severe ankle sprains routinely undergo magnetic resonance imaging (MRI) and receive conservative treatment with a short leg posterior cast splint. This study specifically focused on bone involvement assessed by MRI, rather than soft tissue or functional parameters.
METHODS
We retrospectively reviewed MRI scans of 70 patients with acute moderate (Grade 2) to severe (Grade 3) ankle sprains who presented consecutively between November 2014 and December 2019. Patients with mild sprains (Grade 1) were excluded. Bone bruises were assessed, and all patients were treated with a short leg posterior cast splint extending from the lower leg to the forefoot. Crutches were prescribed when pain persisted during weight-bearing after splint application. Multivariable logistic regression analysis was performed to evaluate the associations between MRI-detected bone bruises and crutch use following fixation.
RESULTS
The fixation period, available in 63 patients, ranged from 8 to 72 days (mean: 29.5 days). Walking pain requiring crutches, used as a proxy indicator of persistent weight-bearing pain rather than a validated clinical outcome, was observed in 32 /70 (45.7%) of patients. All patients experienced resolution of ankle joint pain following treatment. MRI revealed bone bruises in the ankle and midfoot in 57/70 (81.4%) of cases. Midfoot involvement, including the tarsal bones and Chopart joint, was present in 24/70 (34.3%) of cases. The talus was the most frequently affected bone 42/70 (60.0%), followed by the tibia 31/70 (44.3%), tarsal bones 18/70 (25.7%), and calcaneus 15/70 (21.4%). Bone bruises on the talocrural joint surface of the talus were significantly associated with crutch use after fixation (P = 0.041). Multivariable logistic regression analysis identified both younger age (odds ratio [OR] 0.957, 95% confidence Interval [CI] 0.930-0.985, P = 0.003) and bone bruises on the talocrural joint surface of the talus (OR 4.012, 95% CI 1.174-13.713, P = 0.027) as independent predictors of crutch use after fixation. All patients reported resolution of ankle joint pain by the final follow-up, with no persistent or recurrent symptoms documented during the observation period.
CONCLUSION
Bone bruises in the ankle and midfoot are frequently associated with moderate to severe ankle sprains. MRI findings indicate a multifaceted pathophysiology, underscoring the importance of individualized treatment strategies. In cases where bone bruises are present on the talocrural joint surface, midfoot immobilization and a temporary period of non-weight-bearing may be appropriate considerations.
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MRI provides a detailed evaluation of knee injuries, aiding diagnosis and management, and MRI detection of associated abnormalities helps guide treatment and improve patient outcomes.
Abhishek Mishra, A. Singh· International Journal of Pha...· 0 citations
MRI performed after initial symptom improvement yields greater diagnostic accuracy and reduces unnecessary ED imaging and should be selectively reserved for cases with persistent clinical suspicion on physical examination or when results may alter management.
M. Demir, S. Birsel· Comprehensive Medicine· 0 citations
Background: Intervertebral Differential Dynamics (IDD) Therapy is used as a targeted, non-surgical decompression intervention for selected patients with disc-related spinal pain. A previously published cohort reported significant short-term improvements in pain and disability, while paired magnetic resonance imaging (MRI) outcomes were reserved for subsequent analysis.
Objective: To evaluate paired MRI findings and clinical outcomes following IDD Therapy in adults with MRI-confirmed cervical or lumbar disc bulges and herniations.
Methods: This retrospective secondary analysis included 21 adults with 47 treated disc levels who completed a 30-session protocol. Previously published Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) outcomes were linked to paired MRI measurements. Posterior disc contour extension, canal anteroposterior diameter, and disc height were analyzed separately for 14 lumbar and 7 cervical index lesions. Radiographic response and exploratory clinical-imaging correlations were also evaluated.
Results: Mean VAS improved from 5.8 to 1.5 and ODI from 18.5 to 6.5 in the parent cohort. Lumbar mean changes were -1.75 mm for disc contour extension, +1.31 mm for canal diameter, and +0.64 mm for disc height; cervical mean changes were -1.20 mm, +0.89 mm, and +0.53 mm, respectively. All region-specific changes were statistically significant. Global radiographic improvement was observed in 16 of 21 patients and 34 of 47 treated levels. Disc contour reduction was strongly associated with VAS improvement (r=0.95; 95% CI, 0.88-0.98; P<0.001).
Conclusions: Completion of IDD Therapy was associated with substantial clinical improvement and favorable paired-MRI changes in most patients in this selected cohort. Because the study was retrospective, lacked a comparator, used non-standardized clinical imaging, and included only treatment completers, the findings are hypothesis-generating rather than causal.
Tyler Maitland Graham, John Graham· Journal of physical medicine...· 0 citations
ABSTRACT Background Ultrasonography is commonly used to evaluate ligament injuries following acute lateral ankle sprain. However, the clinical significance of structural changes in ligament thickness during the healing process remains unclear. This study aimed to evaluate whether changes in anterior talofibular ligament (ATFL) thickness are associated with functional clinical outcomes. Methods This study was a retrospective analysis of prospectively collected cohort data involving 32 patients with acute lateral ankle sprain enrolled between January 2024 and March 2025. All patients underwent conservative treatment and were followed for up to 12 weeks after injury. Patients were excluded if they had a history of prior ankle sprain, fracture, deformity, previous surgery involving the foot or ankle, or avulsion‐type ATFL injury. Standardized ultrasound examinations were performed at baseline and at 3, 6, and 12 weeks after injury. ATFL thickness was measured bilaterally at the ligament midpoint, and an injured‐to‐healthy thickness ratio was calculated. Functional outcomes were assessed at 12 weeks using the visual analog scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, and Cumberland Ankle Instability Tool (CAIT). Temporal changes were analyzed using repeated‐measures ANOVA, and correlations were assessed using Pearson correlation analysis. Results The ATFL thickness ratio decreased significantly over time (p < 0.05), suggesting progressive structural remodeling during healing. Clinical outcomes improved significantly (all p < 0.001). However, no significant associations were detected between the ATFL thickness ratio and functional outcome measures at any time point (all p > 0.05). Conclusions Although serial ultrasonography demonstrated progressive morphological remodeling of the ATFL following acute lateral ankle sprain, the present study did not detect a significant association between the ATFL thickness ratio and short‐term functional outcomes. These findings suggest that ultrasonographic thickness alone may not fully reflect clinical recovery.
Seung Myung Wi, Dong Hee Kim, Sang Heun Kim et al.· Journal of Foot and Ankle Re...· 0 citations
