The most common pathologic changes occurring in acute ankle inversion trauma are tears to the anterior talofibular and calcaneofibular ligaments, followed by injuries to the sinus tarsi structures and tears to the peroneus longus and brevis tendons, according to a study conducted at a top Russian military hospital.
"Due to numerous combinations of movements in a moment of ankle inversion trauma, different types of injuries can develop," noted lead presenter Dr. I.S. Pashnikova, from the department of radiology, Kirov Military Medical Academy, St. Petersburg, in an e-poster at this month's European Society of MR in Medicine and Biology (ESMRMB) congress in Lisbon. "MRI is the useful modality that can assess both soft-tissue and osseous pathologic changes in acute inversion trauma."
The researchers sought to throw new light on the pattern of injuries in acute ankle inversion trauma and show relations between these injured structures. They conducted an analysis of complex clinical, radiographic, and MRI investigations of 76 patients with acute inversion trauma (47 men, 29 women, average age 39.7 years). All patients went through routine ankle radiography to rule out fracture.
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| The Kirov Military Medical Academy may be converted into a faculty of medicine within St. Petersburg State University. Image courtesy of Naval Today. |
MRI was performed on 1.5-tesla scanners, using routine imaging protocols that included five basic sequences: sagittal T1-weighted images (TR 427 ms, TE 13 ms, averages 2, matrix 320x256, slice thickness 3 mm, dist. factor 0, FOV 16x16 cm); sagittal PD-weighted images with fat saturation (TR 2700 ms, TE 15 ms, averages 2, matrix 320x256, slice thickness 3 mm, dist. factor 0, FOV 16x16 cm); axial PD-weighted images with fat saturation (TR 3930 ms, TE 15 ms, averages 2, matrix 384x192, slice thickness 2.5 mm, dist. factor 0, FOV 10x19.9 cm); coronal PD-weighted images with fat saturation (TR 4150 ms, TE 21 ms, averages 2, matrix 320x134, slice thickness 2.5 mm, dist. factor 0, FOV 9.2x16.4 cm); and oblique coronal 3D-CISS (constructive interference in steady state sequence) images (TR 12.8 ms, TE 6.4 ms, averages 2, matrix 384x208, slice thickness 1.2 mm, dist. factor 20, FOV 9.8x18 cm).
The MR images were then analyzed by two musculoskeletal radiologists in consensus.
The pathologic findings on MRI were: anterior talofibular ligament (ATFL) tear = 63 (83%) (partial = 34, complete = 29); calcaneofibular ligament (CFL) tear = 54 (71%) (partial = 35, complete = 19); posterior talofibular ligament partial tear = 4 (5%); deltoid ligament partial tear =15 (20%); peroneus brevis tendon partial tear = 29 (38%); peroneus longus tendon partial tear = 40 (53%); peroneus tertius tendon tear = 7 (9%) (partial = 5, complete = 2); injury of sinus tarsi structures =46 (61%); osteochondral lesions of the talar dome =11 (14.5%); anterior process calcaneus fracture = 3 (6%); and fifth metatarsal tuberosity avulsion fracture =1 (1%).
In 58 cases, associated injures of several structures were revealed. There were associated tears of ATFL and CFL in at least 21 cases. CFL tears were associated with the injury of sinus tarsi structures in at least 32 cases, and with peroneal tendon tears in at least 36 cases. All cases of osteochondral lesions and fractures of the anterior process calcaneus were associated with the ATFL tear.
"Thus, the most frequent pathological findings in patients with acute ankle inversion trauma were associated lateral complex ligament (ATFL and/or CFL) tears, peroneal tendons -- peroneus longus, peroneus brevis, peroneus tertius tendons -- tears and injuries of sinus tarsi structures (inflammation of sinus tarsal fat tissue and alteration in the structure of sinus tarsi ligaments) in different combinations," the authors stated.
Established in 1798, the Kirov Military Medical Academy trains senior medical staff for the armed forces and conducts research in the medical services area for the military. It is a full-scale medical school with a network of teaching and research clinics and hospitals affiliated with it. A proposal to convert the academy into a faculty of medicine within St. Petersburg State University reportedly is under consideration, but this would involve moving to a new location.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
