Acute ankle sprain including distal tibiofibular syndesmosis injury is the most common lower limb sports injury. In the athletic population, imaging with magnetic resonance imaging plays an important role in the grading of acute ankle sprain but crucially also in the detection of associated injuries, such as bone contusion, osteochondral lesions, fracture, and tendon injury. Accurate diagnosis in the acute phase of injury facilitates surgical decision making, appropriate rehabilitation, and prediction of return-to-play time. This review article examines the medial ligament complex, the lateral ligament complex, and the syndesmosis in detail. It summarizes the normal ligamentous anatomy, mechanisms of injury, and provides imaging examples to illustrate the spectrum of findings in acute ankle sprains.
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