Anterolateral Ankle Pain: Comparison of Two Areas of Clinical Anterolateral Pain Using Imaging and Arthroscopic Findings

Background: Anterolateral ankle pain is a common symptom after ankle sprain in athletes. Although the pathologic conditions producing anterolateral ankle pain have been researched, we still do not know the exact relationship between structural abnormality and anterolateral ankle pain. The aim of this study was to assess two distinct areas of anterolateral ankle pain by comparing magnetic resonance imaging (MRI) and computed tomography (CT) findings with those of arthroscopic examination. Methods: From 2011 to 2014, a total of 32 ankles were examined. Preoperative physical findings, MRI and CT findings, and systematic arthroscopic examination were retrospectively reviewed. Abnormalities of two anterolateral ankle regions, the lateral shoulder and anterior talofibular ligament (ATFL), were recorded. Results: Tenderness over the lateral shoulder region was present in 20 patients (62.5%) and tenderness over the ATFL region was present in 17 patients (54.1%). CT abnormalities were found in 28 patients (87.5%). MRI abnormalities were found in 25 patients (78.1%). On arthroscopy, 32 patients (97.0%) showed abnormalities in the anterolateral area. Statistical analyses showed correlations between pathology on imaging and arthroscopic examinations, and clinical pain. In the lateral shoulder region, synovitis/scar tissue and accessory (Bassett’s) ligament correlated with clinical pain. In the ATFL region, an abnormal ATFL and osteochondrial lesions correlated with clinical pain. Conclusion: Various pathological findings were observed on arthroscopic examination. Although anterolateral impingent syndrome is considered to be due to soft tissue impingement, osteocartilaginous abnormalities were identified in these patients. Inadequate care resulting in scar tissue formation and the presence of microinstability are possibly etiologic factors associated with abnormal findings. In order to prevent these conditions, improvements in the initial treatment of ankle injuries is warranted.