Anterolateral recess of tibiotalar joint:
Bounded posteromedially by tibia, laterally by fibula, anteriorly and laterally by tibiotalar capsule, anterior tibiofibular, anterior talofibular and calcaneofibular ligaments
Mechanism:
Minor trauma in forced plantar flexion and supination - tears in anterolateral capsular tissues and ligaments (but no significant clinical mechanical instability) - synovial scarring, inflammation and hypertrophy in anterolateral recess - impingement
May also lead to hypertrophy of inferior portion of anterior tibiofibular ligament, osseous spurs (rarely)
Clinical features:
Diagnosis of exclusion
Confirmed at arthroscopy
Focal anterolateral pain increased by supination or pronation
Absence of mechanical instability
MR:
Non-arthrographic MR sensitivity 39%–100% and specificity 50%–100
Irregular/nodular anterolateral soft tissue (sensitivity 100%, specificity 100%) with int-to-low signal on all sequences
Best seen on axials between anterior tibiofibular and anterior talofibular ligaments
Meniscoid lesion in chronic impingement
Chondral defects
Osseous spurs
Laxity or rupture of anterior talofibular ligament
Absent recess between anterolateral soft tissues and anterior surface of fibula despite adequate distention by contrast
Management:
Physiotherapy
Debridement
References:
Robinson P et al. Soft-Tissue and Osseous Impingement Syndromes of the Ankle: Role of Imaging in Diagnosis and Management. Radiographics. 2002;22:1457-1469
