MRI Utilization in Acute Ankle Inversion Injuries: Indications and Optimal Timing

Abstract

Objective: Acute ankle inversion injury (AAII) is one of the most common injuries seen in emergency departments (EDs). Although MRI is valuable for diagnosis, its use in the ED is often limited by time, cost, and patient comfort. Moreover, severe post-traumatic symptoms can raise concern for misdiagnosis and prompt unnecessary MRI requests. Therefore, the true necessity of early MRI after AAII has increasingly been questioned. Materials and Methods: A total of 464 patients were included in the study. Group A consisted of 319 patients who underwent MRI during their initial evaluation after trauma, while Group B included 145 patients who received MRI during follow-up based on clinical suspicion. Grade 2 and Grade 3 ligament injuries, osteochondral injuries, tendon injuries, and non-displaced fractures were considered clinically significant pathologies. The proportion of clinically significant findings was compared between the two groups. Results: MRI revealed pathologies that could lead to functional impairment in 79.3% of Group A and 96.5% of Group B (p<0.001). Ligament injury was present in 48.4%, most commonly ATFL tears (42%). Bone and osteochondral lesions were found in 47.6% of patients. All Grade 3 lesions were located in the talus and associated with sports-related trauma (p<0.001). Bone-cartilage lesions were found in 56.5% of sports injuries vs. 46.1% of non-sports injuries (p=0.109). Conclusion: MRI performed after initial symptom improvement yields greater diagnostic accuracy and reduces unnecessary ED imaging. MRI should be selectively reserved for cases with persistent clinical suspicion on physical examination or when results may alter management.