Magnetic resonance imaging as a predictor of return to play following syndesmosis (high) ankle sprains in professional football players

Howard, Daniel R.; Rubin, David A.; Hillen, Travis J.; Nissman, Daniel B.; Lomax, James; Williams, Tyler; Scott, Reggie; Cunningham, Byron; Matava, Matthew J.

Affiliations

¹Department of Orthopedic Surgery, Washington University School of Medicine, Chesterfield, Missouri

²Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri

³Department of Orthopedic Surgery, Washington University School of Medicine

Abstract and keywords

Background: Syndesmosis ankle sprains cause greater disability and longer duration of recovery than lateral ankle sprains.

Objective: To describe the severity of syndesmosis sprains using several accepted magnetic resonance imaging (MRI) criteria and to assess the interrater reliability of diagnosing syndesmosis injury using these same criteria in professional American football players.

Hypothesis: There is a high degree of interrater reliability of MRI findings in American football players with syndesmosis ankle sprains. These radiographic findings will correlate with time lost to injury, indicating severity of the sprain.

Study Design: Uncontrolled retrospective review.

Methods: Player demographics and time lost to play were recorded among professional football players who had sustained a syndesmosis ankle sprain and underwent standardized ankle MRI. Each image was independently read by 3 blinded musculoskeletal radiologists.

Results: Seventeen players met study criteria. There was almost perfect agreement among the radiologists for diagnosing injury to the syndesmotic membrane; substantial agreement for diagnosing injury to the posterior inferior tibiofibular ligament (PITFL) and in determining the proximal extent of syndesmotic edema/injury; but only fair agreement for diagnosing injury to the anterior inferior tibiofibular ligament and in determining the width of syndesmotic separation. There was a significant correlation between the width of syndesmotic separation and time lost, but no significant correlation between individual syndesmotic ligament injury or proximal extent of syndesmotic edema/injury and time lost.

Conclusion: While ankle MRI can identify syndesmotic disruption with a high degree of interobserver agreement, no association was demonstrated between the extent of injury on MRI and the time to return to play following a high ankle sprain.

Clinical Relevance: In athletes with suspected high ankle sprains, MRI may help confirm diagnosis or suggest alternative diagnoses when the syndesmotic supporting structures are intact. However, the severity of ligamentous and syndesmotic disruption on MRI cannot help predict recovery times.

Keywords: syndesmosis; football; ankle; reliability; magnetic resonance imaging

Links

DOI: 10.1177/1941738112462531

Cited Works (18)

Year	Entry
1997	Vogl TJ, Hochmuth K, Diebold T, Lubrich J, Hofmann R, Stöckle U, Söllner O, Bisson S, Südkamp N, Maeurer J, Haas N, Felix R. Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis. Invest Radiol. July 1997;32(7):401-409.
1998	Fallat L, Grimm DJ, Saracco JA. Sprained ankle syndrome: prevalence and analysis of 639 acute injuries. J Foot Ankle Surg. 1998;37(4):280-285.
1995	Brosky T, Nyland j, Nitz A, Caborn DNM. The ankle ligaments: consideration of syndesmotic injury and implications for rehabilitation. J Orthop Sports Phys Ther. April 1995;21(4):197-205.
1977	Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. March 1977;33(1):159-174.
1998	Muhle C, Frank LR, Rand T, Ahn JM, Yeh L-R, Trudell D, Haghighi P, Resnick D. Tibiofibular syndesmosis: high-resolution MRI using a local gradient coil. J Comput Assist Tomogr. November–December 1998;22(6):938-944.
2003	Takao M, Ochi M, Oae K, Naito K, Uchio Y. Diagnosis of a tear of the tibiofibular syndesmosis: the role of arthroscopy of the ankle. J Bone Joint Surg. April 2003;85B(3):324-329.
2003	Beumer A, van Hemert WLW, Swierstra BA, Jasper LE, Belkoff SM. A biomechanical evaluation of clinical stress tests for syndesmotic ankle instability. Foot Ankle Int. April 2003;24(4):358-363.
1998	Teitz CC, Harrington RM. A biochemical analysis of the squeeze test for sprains of the syndesmotic ligaments of the ankle. Foot Ankle Int. July 1998;19(7):489-492.
1992	Taylor DC, Englehardt DL, Bassett FH III. Syndesmosis sprains of the ankle: the influence of heterotopic ossification. Am J Sports Med. March 1992;20(2):146-150.
1990	Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. June 1990;10(6):325-330.
2002	Uys HD, Rijke AM. Clinical association of acute lateral ankle sprain with syndesmotic involvement: a stress radiography and magnetic resonance imaging study. Am J Sports Med. November 2002;30(6):816-822.
1998	Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. October 1998;19(10):653-660.
2004	Brown KW, Morrison WB, Schweitzer ME, Parellada JA, Nothnagel H. MRI findings associated with distal tibiofibular syndesmosis injury. Am J Roentgen. January 2004;182(1):131-136.
2004	Wright RW, Barile RJ, Surprenant DA, Matava MJ. Ankle syndesmosis sprains in National Hockey League players. Am J Sports Med. December 2004;32(8):1941-1945.
2003	Oae K, Takao M, Naito K, Uchio Y, Kono T, Ishida J, Ochi M. Injury of the tibiofibular syndesmosis: value of MR imaging for diagnosis. Radiology. April 2003;227(1):155-161.
1976	Guise ER. Rotational ligamentous injuries to the ankle in football. Am J Sports Med. January–February 1976;4(1):1-6.
1991	Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med. 1991;19(3):294-298.
2001	Nussbaum ED, Hosea TM, Sieler SD, Incremona BR, Kessler DE. Prospective evaluation of syndesmotic ankle sprains without diastasis. Am J Sports Med. January 2001;29(1):31-35.

Cited By (3)

Year	Entry
2020	Prakash AA. Epidemiology of high ankle sprains: a systematic review. Foot Ankle Spec. October 2020;13(5):420-430.
2016	Matava MJ, Görtz S. The university of the National Football League: how technology, injury surveillance, and health care have improved the safety of America's game. J Knee Surg. July 2016;29(5):370-378.
2018	Knapik DM, Trem A, Sheehan J, Salata MJ, Voos JE. Conservative management for stable high ankle injuries in professional football players. Sports Health. January–February 2018;10(1):80-84.