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Osteoarthritis Cartilage. 2014 Oct;22(10):1377-85. doi: 10.1016/j.joca.2014.04.029. Epub 2014 May 9.

Functional ankle instability as a risk factor for osteoarthritis: using T2-mapping to analyze early cartilage degeneration in the ankle joint of young athletes.

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Department of Trauma Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
Institute of Sport Science and Sport, University of Erlangen-Nuremberg, Erlangen, Germany.
Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
Department of Trauma Surgery, University of Erlangen-Nuremberg, Erlangen, Germany; MR Center of Excellence, Department of Radiology, Medical University of Vienna, Vienna, Austria. Electronic address:



The aim of this study was to investigate, using T2-mapping, the impact of functional instability in the ankle joint on the development of early cartilage damage.


Ethical approval for this study was provided. Thirty-six volunteers from the university sports program were divided into three groups according to their ankle status: functional ankle instability (FAI, initial ankle sprain with residual instability); ankle sprain Copers (initial sprain, without residual instability); and controls (without a history of ankle injuries). Quantitative T2-mapping magnetic resonance imaging (MRI) was performed at the beginning ('early-unloading') and at the end ('late-unloading') of the MR-examination, with a mean time span of 27 min. Zonal region-of-interest T2-mapping was performed on the talar and tibial cartilage in the deep and superficial layers. The inter-group comparisons of T2-values were analyzed using paired and unpaired t-tests. Statistical analysis of variance was performed.


T2-values showed significant to highly significant differences in 11 of 12 regions throughout the groups. In early-unloading, the FAI-group showed a significant increase in quantitative T2-values in the medial, talar regions (P = 0.008, P = 0.027), whereas the Coper-group showed this enhancement in the central-lateral regions (P = 0.05). Especially the comparison of early-loading to late-unloading values revealed significantly decreasing T2-values over time laterally and significantly increasing T2-values medially in the FAI-group, which were not present in the Coper- or control-group.


Functional instability causes unbalanced loading in the ankle joint, resulting in cartilage alterations as assessed by quantitative T2-mapping. This approach can visualize and localize early cartilage abnormalities, possibly enabling specific treatment options to prevent osteoarthritis in young athletes.


Functional ankle instability; Magnetic resonance imaging; Osteoarthritis; Sports medicine; T2-mapping

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