Ankle MRI Report Template: Normal, Ligament and Tendon Examples

Normal ankle MRI report: complete example

This framework is for a routine MRI of one ankle and hindfoot without contrast. Confirm laterality and the anatomic coverage: a routine ankle study does not automatically include the entire foot. Adapt the text to the actual sequences, field of view, and clinical question.

Examination: MRI of the right ankle and hindfoot without intravenous contrast.

Clinical indication: [Indication.]

Comparison: [Prior study and date / None available.]

Technique: Multiplanar, multisequence MRI of the right ankle and hindfoot was performed without intravenous contrast.

Findings: Alignment is maintained. Marrow signal is within expected limits, without acute fracture or focal osteochondral lesion of the talar dome. The tibiotalar and subtalar joint spaces are maintained, with no significant effusion. The anterior and posterior inferior tibiofibular ligaments, anterior talofibular, calcaneofibular, and posterior talofibular ligaments, and deltoid ligament complex are intact. The tibialis posterior, flexor digitorum longus, flexor hallucis longus, peroneus longus and brevis, and anterior extensor tendons are intact. The Achilles tendon and plantar fascia are unremarkable. No significant muscle edema, sinus tarsi abnormality, or soft-tissue collection is identified.

Impression: No significant abnormality identified on routine MRI of the right ankle and hindfoot.

Remove or qualify any structure that is not fully included or not adequately assessed. “Normal ankle MRI” should not imply that the entire foot, dynamic stability, or every small articular surface has been evaluated.

Before interpretation

• Match the side on the images and order. Confirm whether the target is the ankle, hindfoot, or a broader foot-and-ankle examination.
• Review the clinical question, trauma mechanism if supplied, prior radiographs, surgery, and available comparison MRI.
• Check that the acquired planes and coverage include the structure relevant to the indication. Note motion, susceptibility from hardware, and other artifacts that limit a specific structure.
• Confirm whether contrast was given intravenously. Routine noncontrast MRI, direct MR arthrography, and a contrast-enhanced tumor or infection study are not interchangeable.
• For a postoperative ankle, identify the operation, graft or repair when known, and the expected region of artifact.

Systematic review checklist

Bones, marrow, cartilage, and joints

Review the distal tibia and fibula, talus, calcaneus, and other included bones. Assess marrow, cortical contour, alignment, and any fracture, stress response, or focal lesion. Inspect the talar dome and other included articular surfaces for osteochondral abnormality and subchondral change. Review the tibiotalar, subtalar, and visible adjacent joints for effusion, synovial thickening, or loose body when adequately covered.

Syndesmosis and ligament complexes

Assess the distal tibiofibular syndesmosis, including the anterior and posterior inferior tibiofibular ligaments and interosseous structures visible on the study. Review the lateral ligament complex—anterior talofibular, calcaneofibular, and posterior talofibular ligaments—and the superficial and deep components of the deltoid complex. Describe fiber continuity, thickening, signal, edema, avulsion, and associated bone injury. A static MRI does not directly measure functional instability.

Tendons and retinacula

Follow the anterior extensor tendons, medial flexor tendons, peroneal tendons, and Achilles tendon. Assess tendon caliber and signal, continuity, sheath fluid, surrounding edema, and position. Review the retinacula when relevant to tendon displacement. Dynamic ultrasound may be more informative for transient tendon subluxation, which a static MRI may not capture.

Sinus tarsi, plantar fascia, muscles, and soft tissues

Review the sinus tarsi, plantar fascia, intrinsic and extrinsic muscles in the field of view, neurovascular structures, and subcutaneous tissues when relevant. Mention a significant ganglion, collection, mass, or edema pattern. A trace amount of tendon sheath fluid or nonspecific edema does not establish a symptomatic diagnosis by itself.

Selected abnormal wording

Lateral ligament sprain: The anterior talofibular ligament is thickened and increased in signal with surrounding edema. Fibers remain in continuity, compatible with a sprain. No avulsion fracture is identified.

Full-thickness ligament tear: Full-thickness discontinuity of the [anterior talofibular / calcaneofibular / anterior inferior tibiofibular] ligament at the [site], with adjacent edema. [No associated avulsion is identified.]

Peroneal tendon: Short-segment longitudinal split tear of the peroneus brevis tendon at the level of the [retromalleolar groove / inframalleolar segment], with [mild] tenosynovial fluid. No tendon dislocation is seen on this static examination.

Osteochondral lesion: Focal [medial / lateral] talar dome osteochondral lesion measuring approximately [dimensions], with [marrow edema / subchondral cyst / cartilage irregularity]. [No displaced fragment is identified.]

State uncertainty when the ligament's partial versus complete disruption cannot be confidently distinguished. Avoid converting a sprain grade or signal change into a functional instability diagnosis.

Fictional worked example: inversion injury

This teaching case is fictional. It demonstrates how to report a ligament injury with associated structures and relevant negative findings.

Examination: MRI of the right ankle and hindfoot without intravenous contrast.

Clinical indication: Right ankle pain after an inversion injury.

Comparison: Right ankle radiographs dated [date].

Technique: Multiplanar, multisequence MRI of the right ankle and hindfoot was performed without intravenous contrast.

Findings: There is full-thickness disruption of the anterior talofibular ligament at its fibular attachment with adjacent edema. The calcaneofibular ligament is mildly thickened and increased in signal, with fibers remaining in continuity. The posterior talofibular, anterior and posterior inferior tibiofibular, and deltoid ligaments are intact. No acute fracture or talar dome osteochondral lesion is identified. There is a small tibiotalar joint effusion. The peroneal tendons remain normally positioned and intact. The remaining flexor and extensor tendons and the Achilles tendon are intact.

Impression:
1. Full-thickness tear of the anterior talofibular ligament at the fibular attachment.
2. Low-grade sprain of the calcaneofibular ligament.
3. Small tibiotalar joint effusion. No fracture or talar dome osteochondral lesion.

The report distinguishes the ligament with fiber discontinuity from the thickened but continuous ligament. It does not infer the degree of functional instability from a static examination.

Protocol limits and common pitfalls

Routine ankle and hindfoot MRI typically uses multiplanar T1-weighted and fluid-sensitive imaging, but protocols vary with the indication. ACR–SPR–SSR guidance emphasizes evaluating the major tendons, ligaments, and joints, and adding bone, marrow, synovium, retinacula, muscles, sinus tarsi, plantar fascia, or neurovascular structures when appropriate. State the acquired coverage and avoid a broader negative claim than the images support.

MRI is static and may not show transient tendon displacement during movement. Ultrasound or stress radiographs may answer selected dynamic questions. CT can provide complementary detail for cortical bone, complex osseous anatomy, and some osteochondral questions. Postoperative metal may obscure adjacent structures even when artifact-reduction techniques are used.

Avoid these shortcuts:

• Saying “all ligaments are intact” after reviewing only the lateral ligaments.
• Calling edema around a ligament a tear without assessing fiber continuity and attachment.
• Calling a tendon tear based only on short-echo signal near a bend; the magic-angle effect can mimic intratendinous signal change.
• Diagnosing tenosynovitis from a trace amount of sheath fluid without supporting findings.
• Calling a talar dome lesion stable or unstable from MRI alone when stability cannot be established.
• Reporting the entire foot as normal when it is not within the field of view.
• Applying a native-ankle template after tendon or ligament repair without considering expected postoperative appearance and artifact.

Primary references

• American College of Radiology, Society for Pediatric Radiology, Society of Skeletal Radiology. Practice Parameter for the Performance and Interpretation of MRI of the Ankle and Hindfoot. Revised 2021, Resolution 44. Official practice parameter (opens in a new tab)
• Antonio GE, Griffith JF. How to Report: Ankle MRI. Seminars in Musculoskeletal Radiology. 2021;25(5):700–708. doi:10.1055/s-0041-1736191 (opens in a new tab)
• Perrich KD, Goodwin DW, Hecht PJ, Cheung Y. Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments. American Journal of Roentgenology. 2009;193(3). doi:10.2214/AJR.08.2286 (opens in a new tab)
• Chang EY, Bencardino JT, French CN, et al. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiology. 2024;53:209–244. doi:10.1007/s00256-023-04420-6 (opens in a new tab)

This educational framework does not replace patient-specific interpretation, current local protocols, or clinical judgment.