Accuracy of radiology MRI reports in predicting syndesmotic injuries: An intraoperative correlation study

This study evaluates the accuracy of MRI radiology reports in identifying syndesmosis injuries compared with arthroscopic findings, the gold standard, in patients with chronic ankle instability or pain. We hypothesised that radiology reports significantly underdiagnose syndesmotic injury relative to true instability confirmed by arthroscopy. A retrospective chart review identified 73 patients who underwent both ankle arthroscopy and MRI at our institution between August 2024 and September 2025. Only MRI reports specifically commenting on the syndesmosis were included. Arthroscopic diagnosis relied on a positive drive-through test (Guyton). The cohort comprised 28 females and 45 males (mean age 35.94 ± 14.93 years), with 36 chronic and 37 acute injuries; 9 had associated fractures. MRI reports demonstrated 100% specificity and positive predictive value, but only 48% sensitivity, 25.6% negative predictive value, and 56.2% overall accuracy. MRI is specific but insensitive for syndesmotic injury; clinicians should review imaging directly rather than rely solely on written reports.