If your ankle MRI report says chronic thickening of the ATFL, that line on its own does not mean your ankle is torn or unstable. Dr. Nick Strasser, foot and ankle surgeon at Vanderbilt and Chief of the Foot and Ankle division, said this finding turns up constantly, especially in athletic patients, and that the scan was often ordered for something else entirely. What matters is what the ankle does, not only what the image records.
What does chronic thickening of the ATFL mean on my report?
It means the radiologist is describing a ligament that looks thicker and less tidy than the textbook version, usually because it was injured at some point in the past and healed that way.
The ATFL, short for anterior talofibular ligament, is the small band on the outside front of the ankle. It is the structure that takes the damage when you roll your ankle inward, the classic sprain. When it heals it tends to come back thicker and a little disorganized, and that is what shows on imaging years later.
when you look at a lot of MRIs, a lot of patients especially the ones that are athletic have some form of a chronic injury to their ATFL
A useful comparison is the knee you scraped badly as a child. The skin closed over, the spot is still slightly thicker and a different color, and all it records is that something happened there once. The record is not the same as an ongoing injury.
Why did a scan ordered for something else find an old ankle sprain?
Because an MRI photographs everything in the field, not only the structure anybody was asking about. Dr. Strasser described patients coming in for an unrelated complaint, a peroneal tendon problem for example, and the report mentions the ATFL along the way.
He said patients ask about that line all the time, and that part of his job is explaining that it is signal on an image. Imaging is sensitive. It picks up history as readily as it picks up a current problem, which is why the finding gets interpreted next to what the person reports and what the exam shows rather than on its own. [verify: published prevalence of incidental ATFL thickening on MRI in asymptomatic ankles]
My ankle feels tight, not loose. Is that the problem?
Tight is the far more common complaint, and Dr. Strasser made the point that when an ankle with an old sprain feels tight, it frequently feels fine to the person living in it.
That lines up with what we see in rehab. Very few people arrive with an ankle that has more motion than they can control. Most arrive with an ankle that has quietly given up range: it stiffens after sitting, it pinches in front when the knee travels forward over the foot, and the calf has gotten weaker because the ankle stopped asking much of it.
- Stiffness after sitting or first thing in the morning.
- A pinch at the front of the ankle in a deep squat or going down stairs.
- A weaker push off on that side, often noticed when running or on a single leg heel raise.
- A sense that the ankle is guarded, rather than a sense that it gives way.
Giving way is a different story and worth saying out loud to a clinician. It is just not what most people with a thickened ATFL on a report are actually experiencing.
What should I do with a report that says my ligament is abnormal?
Take it to someone who will put it next to how the ankle behaves. The report is context, not a verdict.
On our side, the questions are practical. How much ankle motion is there, and where does it stop. How strong is the calf and foot, and how does that compare side to side. Can the person control the range they have on one leg. Those answers are what rehabilitative care is built around, and they are also what is most useful to send back to the referring physician or surgeon.
At Active Sports Therapy, that is the division of labor we are comfortable with. The imaging and the surgical decisions belong to the physician. Motion, strength and how an ankle handles load belong to us, before an operation and after one.
Key points
- Chronic ATFL thickening is a common MRI read, especially in athletic patients.
- Dr. Strasser said many of these scans were ordered for an unrelated complaint.
- A healed ligament looks thicker on imaging, which is a record of history.
- Most ankles with an old sprain feel tight rather than loose.
- Available motion, strength and control are what rehab measures and works on.
Frequently asked questions
Is chronic ATFL thickening serious?
Usually it is a historical finding rather than an active injury, and Dr. Strasser described it as something he sees constantly. It becomes more interesting when it sits alongside real symptoms such as the ankle giving way. Your physician is the one who reads the report against your exam.
Why does my ankle feel tight years after a sprain?
Healed ligament tissue is thicker and less elastic, and people tend to move the ankle less after an injury without noticing. Over time that usually reads as stiffness rather than looseness. Many people find that motion and calf strength work changes how the ankle feels through the day.
Do I need an MRI for an ankle that feels fine?
Imaging is ordered to answer a specific question, and an ankle that is not bothering you rarely poses one. That decision belongs to your physician. Scanning a quiet ankle often finds old changes that then need explaining.
What if my ankle actually does give way?
Repeated giving way on uneven ground is worth reporting, because that is the presentation where instability is genuinely in the conversation. It is also the presentation where strength, balance and control work has the most to offer. Start by having the ankle assessed rather than deciding from the report.
If an ankle report has you worried, or that ankle has felt stiff since a sprain years ago, book a new patient visit at our Hendersonville office and we will see what that ankle can actually do.
Active Sports Therapy · 123 Stadium Drive, Hendersonville, TN 37075 · 615-537-5520
Sources
- Hertel J, Corbett RO. An Updated Model of Chronic Ankle Instability. Journal of Athletic Training, 2019. https://doi.org/10.4085/1062-6050-344-18
- Valderrabano V, Hintermann B, Horisberger M, Fung TS. Ligamentous posttraumatic ankle osteoarthritis. American Journal of Sports Medicine, 2006. https://doi.org/10.1177/0363546505281813
- Delco ML, Kennedy JG, Bonassar LJ, Fortier LA. Post-traumatic osteoarthritis of the ankle. Journal of Orthopaedic Research, 2017. https://doi.org/10.1002/jor.23462
Transcript of the video
They do they stretch do you feel like you see remnants of old injury there? What’s what’s that really liked and elderly population when you have to go in there and see some of these these ligaments you feel like you have to do something for them. Mostly. I mean in that in that population, you know, you don’t get a lot of patients in that that come in with ankle instability.
Yeah. Yeah. So that’s probably dealing with more of a degenerative condition. Yes.
Usually when you get to that point where it’s a degenerative ankle, sometimes you see degenerative Taylor Joynt things like that the everything around it is just abnormal and what I don’t know maybe what I don’t know is Like is that because this the ligaments don’t look normal. I do know that when you look at a lot of MRIS. A lot of them and a lot of patients especially the ones that are athletic have some form of a chronic injury to their atfl and that gets read almost always chronic Frank chronic thickening of the atfl, you know, and and patients come in and ask about that all the time. Sometimes they’re getting a an MRI for something unrelated.
Yes killing these peroneal or whatever and you have to kind of explain like well, that’s right just signal. Yeah and special when it feels tight. It feels good, you know, nothing on physical exams popping off. Yeah.
With Dr. Nick Strasser, foot and ankle surgeon at Vanderbilt and Chief of the Foot and Ankle division. See his practice.
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