Baltes, Thomas P.A.Dalansi, FerielAl-Naimi, Maryam R.Bordalo, MarceloHoltzhausen, LouisWhiteley, RodCardinale, MarcoD'Hooghe, PieterKerkhoffs, Gino M.M.J.Tol, Johannes L.2025-09-122025-09-122025-07Baltes, T.P.A., Dalansi, F., Al-Naimi, M.R., et al. The Prevalence, Size, and Anatomic Location of Cartilage and Osteochondral Lesions in Athletes With an Acute Ligamentous Ankle Injury. The American Journal of Sports Medicine. 2025; 53(9): 2173-2180. doi: 10.1177/03635465251344187.0363-5465 (print)1552-3365 (online)10.1177/03635465251344187http://hdl.handle.net/2263/104296BACKGROUND : In athletes with an acute ligamentous ankle injury, cartilage and osteochondral lesions ([O]CLs) have been reported in 8% using 1.5-T magnetic resonance imaging (MRI). Visualization of cartilage injuries improves with the use of higher field strengths. PURPOSE : To evaluate the prevalence, size, and anatomic location of (O)CLs in athletes with an acute ligamentous ankle injury using 3-T MRI, as well as to determine the association of (O)CLs with injury of (1) the lateral ankle ligaments and (2) anterior syndesmosis. STUDY DESIGN : Cohort study; Level of evidence, 3. METHODS : For this prospective cohort study, all acute ligamentous ankle injuries in athletes (≥18 years of age) evaluated in the outpatient department of a specialized orthopaedic and sports medicine hospital within 7 days after injury were assed for eligibility. Acute ankle injuries were excluded if 3-T MRI could not be obtained within 10 days after injury or if imaging demonstrated a frank fracture. A musculoskeletal radiologist assessed MRI scans for the presence, location, and size of (O)CLs. Morphology was graded using the modified Berndt and Harty score, Griffith MRI score, and International Cartilage Regeneration & Joint Preservation Society score. In addition, injuries of the lateral ankle ligaments and anterior syndesmosis were graded. A multivariate logistic regression analysis was performed to evaluate the association between (O)CLs and injury of the (1) lateral ankle ligaments and (2) anterior syndesmosis. RESULTS : Between September 2016 and February 2020, 171 acute ankle injuries in 166 athletes were included in this study. The overall prevalence of (O)CLs was 14%. (O)CLs of the talus and tibia were observed in 24 (14%) and 9 (5%) acute ankle injuries, respectively. Of 33 (O)CLs, 28 (85%) were classified as cartilage lesions. Lateral ligament injury was observed in 73% of acute ankle injuries, and anterior syndesmosis injury in 38%. Multivariate logistic regression analysis did not show significantly higher odds of (O)CLs in the presence of anterior syndesmosis injury (OR, 2.16; 95% CI, 0.90-5.16). CONCLUSION : In athletes with an acute ligamentous ankle injury, a prevalence for (O)CLs of 14% was established using 3-T MRI. The majority were cartilage lesions. No statistically significant association was established between (O)CLs and lateral ligament or syndesmosis injury was established.en© 2025 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 Lficense (https://creativecommons.org/licenses/by/4.0/).Ankle sprainCartilage injuryOsteochondral lesionsAnkle ligamentsMagnetic resonance imaging (MRI)Article