![]() The most common impingement is anterolateral impingement, followed by posterior and anterior impingement. Posttraumatic changes such as local synovitis, scars, thickened articular capsule or ligaments, and osteophytes may cause different impingement syndromes based on the localization. īME can be a very sensitive sign in the different types of impingement. MRI can detect a stress fracture in the early stages. Intracortical changes occur while the limb is still bearing weight. A slight periosteal edema is the first sign of stress fracture which, in the absence of treatment, is followed by BME in the medullary cavity. Linear low-signal disturbances oriented perpendicular to the load axis, usually surrounded by extensive BME, are consistent with stress fracture (Fig. In these situations, a fatigue fracture or insufficiency fracture, respectively, may occur. This happens with weakened bone tissue (osteopenia) or with vigorously repeated mechanical forces (Fig. When the bony trabecular load is higher than normal, loss of mechanical integrity through injury is possible. 9)-functional dysfunction, overuse, or ruptures. 8) BME in the posterior half of the lateral malleolus with pathology in the peroneal tendons (Fig. Reticular BME in the posterior half of the medial malleolus is seen with dysfunction of the tibialis posterior tendon (Fig. The absence of a hypointense line on T1-weighted images excludes a complete fracture which needs a different treatment (Fig. The distribution of BME seen in specific types of injury thus represents one of the most useful differential diagnostic clues in ankle trauma.īy firstly determining if there is BME on only one side of the ankle joint or it is multifocal and secondly the type of BME, the BME pattern can reveal the mechanism of injury. Type III is often associated with a fracture or osteochondral lesion thus, it may have a different extent. This classification helps to determine the cause of the BME: type I usually corresponds to an injury from a contrecoup mechanism making it more extensive, whereas type II usually indicates trauma to the ligament attachment, articular capsule, or retinaculum and therefore is more localized. Type III: The BME often has slight deformation or disruption of the bony outline Type II: Localized or geographic BME, often with a convex margin and contiguous to the articular cartilage or bony outline Type I: Diffuse or reticular BME, at some distance from the articular cartilage Early avascular necrosis, inflammation, or stress fracture may lead to more diffuse BME therefore, a detailed medical history is crucial for correct diagnosis.Ī systematic analysis of BME on MRI can help to determine the trauma mechanism and thus assess soft tissue injuries and help to differentiate between different etiologies of nontraumatic BME.Ĭosta-Paz et al. Degenerative changes or minor cartilage damage may lead to subchondral BME. Changed mechanical forces between bones in coalition may lead to BME. Bone in direct contact with a tendon may lead to alterations in the bone marrow signal where BME may indicate tendinopathy or dynamic tendon dysfunction. In other cases, a consideration of the distribution of BME may indicate the mechanism of injury or impingement. The BME pattern following an inversion injury involves the lateral malleolus, the medial part of the talar body, and the medial part of the distal tibia. ![]() The distribution of BME allows for a determination of the trauma mechanism and a correct assessment of soft tissue injury. The presence of BME is an unspecific but sensitive sign of primary pathology and may act as a guide to correct and systematic interpretation of the MR examination. This article will provide a systematic overview of the most common disorders in the ankle and foot associated with BME. Bone marrow edema (BME) is one of the most common findings on magnetic resonance imaging (MRI) after an ankle injury but can be present even without a history of trauma.
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