Slideshow: Ankle Impingement Syndrome in Athletes

Figure 1a. Pigmented villonodular synovitis (PVNS).

Figure 1b. Tram lesion

Figure 1c. Lateral gutter fibrosis

Figure 1d. Synovitis

Figure 1e. Synovitis

Figure 1f. Posterior tib-fib accessory ligament (posterior scope)

Figure 2. Postoperative scarring typically seen post–ankle ORIF
a. Initial entry into the joint after limited debridement

Figure 2. Postoperative scarring typically seen post–ankle ORIF
b. Post-debridement

Figure 3. Anterior ankle
a. Normal fluid pattern

Figure 3. Anterior ankle
b. Joint effusion anteriorly, posterior fluid is within normal range
 

Figure 3. Anterior ankle
c. Osteochondral fragment
 

Figure 3. Anterior ankle
d. Multiple structures anteriorly and posteriorly, all abnormal

Figure 4. A 36-year-old soldier. Of note the soldier’s MRI was read as a normal MRI by the radiologist. Despite a normal reading, there are significant findings both anteriorly and posteriorly that warrant a combination scope.
a. T1 image—red line shows the anterior joint capsule

Figure 4. A 36-year-old soldier. Of note the soldier’s MRI was read as a normal MRI by the radiologist. Despite a normal reading, there are significant findings both anteriorly and posteriorly that warrant a combination scope.
b. T2 image—anterior capsule is filled with heterogenous material which is more than likely synovitis

Figure 4. A 36-year-old soldier. Of note the soldier’s MRI was read as a normal MRI by the radiologist. Despite a normal reading, there are significant findings both anteriorly and posteriorly that warrant a combination scope.
c. Dense object sitting in the posterior ankle joint.
 

Figure 4. A 36-year-old soldier. Of note the soldier’s MRI was read as a normal MRI by the radiologist. Despite a normal reading, there are significant findings both anteriorly and posteriorly that warrant a combination scope.
d. More than likely a meniscoid band that is well mature

Figure 5. 35-year-old male soldier. MRI report was focused on the cartilage lesion and ignored all the soft tissue pathology, which was noted anterior and posteriorly. 
a. Red arrow shows significant joint effusion anteriorly
 

Figure 5. 35-year-old male soldier. MRI report was focused on the cartilage lesion and ignored all the soft tissue pathology, which was noted anterior and posteriorly. 
b. Varicose veins

Figure 6. 30-year-old female soldier. Anterior fragment in the anterior joint capsule. Radiology report missed the fragment. Of note, the fragment was not visible on X-ray.
a. Small ossification in anterior joint
 

Figure 6. 30-year-old female soldier. Anterior fragment in the anterior joint capsule. Radiology report missed the fragment. Of note, the fragment was not visible on X-ray.
b. Fragment is surrounded by synovitis

Figure 7. 25-year-old male soldier. Radiology report was normal. One only has to look at the normal X-ray and see how obvious the pathology was on the MRI.  Cartilaginous pieces or non-osseous pieces often are exposed on MRI versus CT or X-ray. 
a. X-ray shows no anterior fragments
 

Figure 7. 25-year-old male soldier. Radiology report was normal. One only has to look at the normal X-ray and see how obvious the pathology was on the MRI.  Cartilaginous pieces or non-osseous pieces often are exposed on MRI versus CT or X-ray. 
b. T1 image shows anterior fragment that is dense
 

Figure 7. 25-year-old male soldier. Radiology report was normal. One only has to look at the normal X-ray and see how obvious the pathology was on the MRI.  Cartilaginous pieces or non-osseous pieces often are exposed on MRI versus CT or X-ray. 
c. T2 image shows the dense lesion
 

Figure 7. 25-year-old male soldier. Radiology report was normal. One only has to look at the normal X-ray and see how obvious the pathology was on the MRI.  Cartilaginous pieces or non-osseous pieces often are exposed on MRI versus CT or X-ray. 
d. T2 coronal shows how large the lesion is coming off the medial capsule