https://orcid.org/0000-0003-2198-3678
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Abstract
Purpose
Ankle injuries are frequent sports injuries. Despite optimizing treatment strategies during recent years, the percentage of chronification following an ankle sprain remains high. The purpose of this review article is, to highlight current epidemiological, clinical and novel advanced cross-sectional imaging trends that may help to evaluate ankle sprain injuries.
Methods
Systematic PubMed literature research. Identification and review of studies (i) analyzing and describing ankle sprain and (ii) focusing on advanced cross-sectional imaging techniques at the ankle.
Results
The ankle is one of the most frequently injured body parts in sports. During the COVID-19 pandemic, there was a change in sporting behavior and sports injuries. Ankle sprains account for about 16–40% of the sports-related injuries. Novel cross-sectional imaging techniques, including Compressed Sensing MRI, 3D MRI, ankle MRI with traction or plantarflexion-supination, quantitative MRI, CT-like MRI, CT arthrography, weight-bearing cone beam CT, dual-energy CT, photon-counting CT, and projection-based metal artifact reduction CT may be introduced for detection and evaluation of specific pathologies after ankle injury. While simple ankle sprains are generally treated conservatively, unstable syndesmotic injuries may undergo stabilization using suture-button-fixation. Minced cartilage implantation is a novel cartilage repair technique for osteochondral defects at the ankle.
Conclusion
Applications and advantages of different cross-sectional imaging techniques at the ankle are highlighted. In a personalized approach, optimal imaging techniques may be chosen that best detect and delineate structural ankle injuries in athletes.
Abbreviations
AITFL, anteroinferior tibiofibular ligament; AMIC, autologous matrix-induced chondrogenesis; AOSS, Ankle Osteoarthritis Scoring System; ATFL, anterior talofibular ligament; BME, bone marrow edema; CFL, calcaneofibular ligament; COVID-19, coronavirus disease 2019; CS, compressed sensing; CT, computed tomography; CTA, CT arthrography; FIFA, Fédération Internationale de Football Association; MACI, matrix-associated chondrocyte implantation; MAR, metal artifact reduction; MARS, metal artifact reduction sequences; MOCART, magnetic resonance observation of cartilage repair tissue; MRA, MR arthrography; MRI, magnetic resonance imaging; NFL, National Football League; OCT, autologous osteochondral transplantation; PD, proton density weighted; PITFL, posteroinferior tibiofibular ligament; PRP, platelet-rich plasma; PTFL, posterior talofibular ligament; SEMAC, slice-encoding for metal artifact correction; SNR, signal-to-noise ratio; SOAS, shoulder osteoarthritis severity; TSE, turbo spin echo; T1GRE, T1w spoiled gradient-echo; UTE, ultra-short echo time, WORMS, Whole-Organ Magnetic Resonance Imaging Score; ZTE, zero echo time; 3D, three-dimensional; 3T, three Tesla; 7T, seven Tesla.
Acknowledgments
We acknowledge support by the Open Access Publication Fund of the University of Freiburg. The author MJ is supported by the Berta-Ottenstein-Program for Clinician Scientists, Faculty of Medicine, University of Freiburg.
Author Contributions
All authors made a significant contribution to the work reported (conception, study design, execution, acquisition of data, analysis and/or interpretation). All authors have drafted, written, and/or substantially revised and/or critically reviewed the article. All authors have agreed on the journal to which the article will be submitted. All authors reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage. All authors agree to take responsibility and be accountable for the contents of the article.
Disclosure
Prof. Dr. Fabian Bamberg reports grants, personal fees from Bayer Healthcare and Siemens Healthineers, during the conduct of the study. The authors report no other conflicts of interest in this work.