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Ankle: Anterolateral Gutter Impingement


50-year-old female with history of injury and subsequent persistent ankle pain and locking.  Clinically suspected impingement.

1.  Moderate scarring of the deltoid ligament complex which could be a source of posteromedial ankle impingement (PoMI lesion).  There is adjacent mild to moderate tendinosis and tenosynovitis involving the tibialis posterior and flexor digitorum longus tendons.
2.  Significant scarring and irregularity of the anterior talofibular ligament with chronic appearing periosteal stripping occurring at the fibular origin.  There is scar tissue and synovitis within the anterolateral gutter as well as a 5-mm osteochondral loose body.  These likely present sources of anterolateral gutter impingement.  The osteochondral loose body likely originates from a full-thickness sharply marginated chondral loss along the anterior aspects of the tibial plafond measuring 6 x 8 mm in dimension.

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  1.  Paterson R, Brown J, Roberts S.  The American Journal of Sports Medicine: 2001 – vol. 29, pp. 550-557.
  2.  Sanders T, Rathur S.  Magnetic Resonance Imaging Clinics of North America:  2008 – vol. 16, pp. 29-38.