An inversion sprain tears the ATFL, then the CFL; a high sprain tears the syndesmosis; the report adds the osteochondral lesion of the talus and the peroneal tendons that explain persistent pain.
Orient first
- ATFL tears first; CFL and PTFL follow in more severe injuries.
- Syndesmotic (high) sprains take longer to heal and may need fixation.
- Persistent pain after a "simple sprain": osteochondral lesion, peroneal tear, sinus tarsi syndrome, anterolateral impingement.
Acquire the study
- Axial, coronal and sagittal PD fat-saturated and T1, 3 mm.
The manoeuvre
- Axial: ATFL — thickened, attenuated or absent; PTFL.
- Coronal and axial: CFL deep to the peroneal tendons.
- Axial at the tibial plafond: anterior and posterior inferior tibiofibular ligaments (syndesmosis).
- Coronal: deltoid ligament (deep and superficial).
- Talar dome osteochondral lesion: size in mm, stability (fluid undercutting).
What confirms it
- Ligament discontinuity or absence with a compatible injury history.
What licenses you to exclude it
- Intact ligaments on MRI exclude a significant tear.
The classic misread
- The normally striated PTFL called torn.