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Posterior Tibiotalar Ligament Injury Resulting in Posteromedial Impingement

Objective: To describe the imaging features of the normal anatomy and injury of the posterior tibiotalar ligament (PTTL) of the ankle in a group of patients presenting with posteromedial impingement. Materials and Methods: Twenty-five consecutive patients underwent imaging for posteromedial ankle pain following injury. All 25 patients were investigated with MR imaging, 17 with ultrasound and 5 with radionuclide bone scanning. Clinical data and surgical findings were correlated with the results of radiological investigation. Results: The PTTL demonstrated scar formation and a hypertrophic response consistent with previous injury in all 25 patients. Displacement or encasement of the surrounding tendons and their sheaths was often encountered (12/25). Bony avulsion was demonstrated in 5/25 occasions with ultrasound and 2/25 with MR imaging. Twelve patients underwent surgery, confirming the radiological findings. Conclusion: Imaging can effectively evaluate the integrity of the PTTL in the context of ongoing posteromedial ankle pain.