We evaluated the reliability of the radiographic talar tilt test by MRI examinations in 112 athletes with injuries to the lateral ligaments of the ankle. 25 athletes with a talar tilt > 15 degrees were treated operatively. Intraoperative findings and the talar tilt test were compared with MR imaging results. Our results suggest that MRI is a reliable method for diagnosing injuries of the lateral ankle ligaments. The talar tilt test cannot evaluate the specific pathology of lateral ankle ligaments, but it was reliable in indicating complete double-ligament ruptures (anterior talofibular and calcaneo-fibular ligaments), when talar tilt was 15 degrees or more than on the uninjured side.