Ligament and Tendon Injuries

Abstract

Several ankle ligaments ensure the static and dynamic stability of the ankle joint, but they are prone to injury due to acute trauma as well as repetitive ankle sprains. Ligamentous ankle pathology mainly involve the lateral ligaments and to a lesser extent the deltoid and syndesmotic ligaments. Although imaging is often not required in the assessment of a low-grade ankle sprain, ligament injuries can be adequately evaluated with ultrasound because of the superficial position of most ankle ligaments. In the case of progressive symptoms, MRI or SPECT/CT imaging can be performed to exclude bony fractures or osteochondral injuries. Moreover, MRI can be used to detect and grade ligament injuries. SPECT/CT will be able to detect more subtle avulsion fractures; furthermore, SPECT/CT can show specific uptake patterns at the bony insertions of the ankle ligaments in different ligamentous injuries.

Tendon injuries around the ankle mainly involve the plantar fascia, the Achilles tendon, the posterior tibial tendon and the peroneal tendons. Acute and chronic tendon injuries can accurately be evaluated by ultrasound and MRI. Although bone SPECT/CT is primarily performed to visualize osteo-articular pathology, inflammatory tendinopathies can show specific patterns of increased vascular uptake on planar bloodpool images as well as on bloodpool SPECT/CT images; reactive bony uptake at tendinous insertions or alongside adjacent bony grooves can also be indicative of a tendinopathy.