Ankle radiographs normal, suspected osteochondral lesion. Next study. Osteochondral injuries may involve the talar dome and, less commonly, the tibial plafond and tarsal navicular bone [5,26,27]. If this injury is associated with fracture, osseous cyst, or osteochondral defect, radiography may show the abnormality; however, radiography often fails to show the extent of the osteochondral injury and will be Chronic Ankle Pain initially negative if the injury is limited to the articular hyaline cartilage. One multimodality study [5] showed that 41% of osteochondral abnormalities of the ankle were missed on radiography. MRI In one multimodality study, MRI performed similarly to arthroscopy for the evaluation of osteochondral abnormalities of the ankle [5]. Although MRI had the highest sensitivity (96%), it was less specific than CT [5]. MRI is effective in determining osteochondral injury instability (sensitivity 97%), most commonly appearing as a high signal line deep to the osteochondral lesion on T2-weighted images or less commonly as a focal defect, an articular fracture, or an adjacent cyst [28]. MRI has also been used to stage these lesions preoperatively with an accuracy of 81% [29] and to assess osteochondral abnormalities after cartilage repair [30]. Although MRI may be less reliable than CT arthrography for talar cartilaginous lesions (accuracy between 76% to 88%) [6], high- resolution MRI using a microscopy coil (eg, a 4-cm receive-only surface coil) can assist in detecting small, clinically relevant features of talar osteochondral lesions that may be missed on standard MRI, including osteochondral junction separation due to focal collapse of the subchondral bone, reparative cartilage hypertrophy, and bone separation in the absence of cartilage fracture [31]. CT Arthrography The introduction of contrast into the ankle joint prior to CT will outline a cartilage surface defect, assisting in lesion detection and assessment for instability.
Chronic Ankle Pain. Ankle radiographs normal, suspected osteochondral lesion. Next study. Osteochondral injuries may involve the talar dome and, less commonly, the tibial plafond and tarsal navicular bone [5,26,27]. If this injury is associated with fracture, osseous cyst, or osteochondral defect, radiography may show the abnormality; however, radiography often fails to show the extent of the osteochondral injury and will be Chronic Ankle Pain initially negative if the injury is limited to the articular hyaline cartilage. One multimodality study [5] showed that 41% of osteochondral abnormalities of the ankle were missed on radiography. MRI In one multimodality study, MRI performed similarly to arthroscopy for the evaluation of osteochondral abnormalities of the ankle [5]. Although MRI had the highest sensitivity (96%), it was less specific than CT [5]. MRI is effective in determining osteochondral injury instability (sensitivity 97%), most commonly appearing as a high signal line deep to the osteochondral lesion on T2-weighted images or less commonly as a focal defect, an articular fracture, or an adjacent cyst [28]. MRI has also been used to stage these lesions preoperatively with an accuracy of 81% [29] and to assess osteochondral abnormalities after cartilage repair [30]. Although MRI may be less reliable than CT arthrography for talar cartilaginous lesions (accuracy between 76% to 88%) [6], high- resolution MRI using a microscopy coil (eg, a 4-cm receive-only surface coil) can assist in detecting small, clinically relevant features of talar osteochondral lesions that may be missed on standard MRI, including osteochondral junction separation due to focal collapse of the subchondral bone, reparative cartilage hypertrophy, and bone separation in the absence of cartilage fracture [31]. CT Arthrography The introduction of contrast into the ankle joint prior to CT will outline a cartilage surface defect, assisting in lesion detection and assessment for instability.