ABSTRACT
BACKGROUND: Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially influencing return to full participation. HYPOTHESIS: In National Football League (NFL) players, isolated high ankle sprains are rare and syndesmosis injuries with concomitant pathology will result in increased time to return to full participation. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Distal tibiofibular syndesmosis injuries sustained by NFL players between 2017 and 2019 were identified through NFL Injury Surveillance Database queries and verified with video analysis. Each injury underwent a comprehensive magnetic resonance imaging (MRI) review. Regression modeling was utilized to explore the influence of numerous imaging findings on time to return to full participation. RESULTS: There were 83 external rotation ankle injuries involving the syndesmosis. Isolated distal tibiofibular syndesmosis injuries were rare (n = 11; 13%) and more often associated with other ligamentous injury (deltoid ligament and lateral ligamentous complex) and/or fractures. Regression modeling resulted in clustering of 3 injury pattern groups for time to return to full participation across numerous imaging findings: syndesmosis injury-fracture combinations (250 days [interquartile range [IQR,] 142-266 days]), syndesmosis injury with complete deep deltoid tear or acute diastasis (175 days [IQR, 20-248 days]), and all other syndesmosis injuries (27 days [IQR, 18-46 days]). CONCLUSION: In NFL athletes with external rotation ankle injuries, isolated distal tibiofibular syndesmosis injuries were rare and more often associated with concomitant pathology. Time to return to full participation was affected by an associated fracture and complete deep deltoid ligament tear or diastasis but no other relevant MRI variables such as lateral ligament complex involvement or the presence of osteochondral lesions or bone contusions.
ABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the necessity of intra-articular gadolinium versus saline alone in magnetic resonance arthrography (MRA) of the shoulder. MATERIALS AND METHODS: Our database was reviewed for 100 consecutive shoulder MRA examinations performed between January 2007 and December 2007. Patient information was blinded and images were retrospectively reviewed by at least two radiologists with dedicated musculoskeletal training. T2-weighted (T2W) images were initially analyzed in isolation to simulate MRA with saline alone. After a delay, the full study was analyzed including T1-weighted (T1W) and T2W images. If there was a significant discordance between the two analyses with regard to rotator cuff or labral pathology, the study was again reviewed by all evaluators in consensus to determine if the T1W images offered additional diagnostic information and increased diagnostic confidence. RESULTS: Of the 100 MRA examinations, there were 15 discordant cases. Two cases were discordant with regard to rotator cuff pathology and 13 were discordant on the basis of labral pathology. When the discordant cases were reviewed in consensus, the T2W images appeared to display rotator cuff and labral pathology as definitively as the T1W images. Interobserver and intraobserver variability was favored to have played a role in causing the discordances. CONCLUSIONS: MRA of the shoulder performed with joint distention provided by saline alone appears to offer equivalent diagnostic information to MRA performed with gadolinium enhancement. This protocol modification improves efficiency by eliminating several image series and provides a small cost savings by eliminating gadolinium.
