Abstract
The present study aimed to evaluate the sensitivity and specificity of clinical tests
and ultrasonography in detecting ankle ligament injuries. In this cross-sectional
study, 105 patients with a history of ankle sprain were included. Ankle ligaments,
including syndesmosis of ankle, as well as deltoid, calcaneofibular, anterior talofibular,
and posterior talofibular ligaments were evaluated by clinical tests, ultrasonography,
and magnetic resonance imaging. The sensitivity and specificity of ultrasound and
clinical tests were assessed in normal, sprain, partial tear, and complete tear groups.
The inter-observer reliability (Cohen's Kappa score) of the evaluated techniques with
magnetic resonance imaging was assessed. Anterior drawer test showed a sensitivity
and specificity of 81 and 80% in the detection of anterior talofibular ligament injuries,
respectively. Ultrasonography showed 100% sensitivity and specificity in distinguishing
normal anterior talofibular ligament from the torn or sprained ligament with a kappa
value of 1. The sensitivity of ultrasonography in detecting normal calcaneofibular
ligament and deltoid ligament was 93% and 90%, respectively. Ultrasonography was highly
specific in detecting calcaneofibular ligament tear but it was not sensitive in this
regard. Ultrasonography was proved reliable in determining the normal anterior talofibular
ligament and calcaneofibular ligament from the torn or sprained ligament. Ultrasonography
is an effective complementary tool for primary evaluation of ankle injuries, which
leads to early diagnosis and efficient quality of care. Clinical tests are not reliable
to rule out the ankle ligaments injury and the results should be interpreted with
caution.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.Sports Med. 2014; 44: 123-140
- Anterior talocrural joint laxity: diagnostic accuracy of the anterior drawer test of the ankle.J Orthop Sports Phys Ther. 2013; 43: 911-919
- Accuracy of magnetic resonance imaging in diagnosing lateral ankle ligament injuries: a comparative study with surgical findings and timings of scans.Asia Pac J Sports Med Arthrosc Rehabil Technol. 2017; 7: 15-20
- Correlation of clinical examination, magnetic resonance imaging and surgical findings in diagnosing ankle joint ligament injuries.Eur J Mol Clin Med. 2020; 7: 1474-1484
- High resolution ultrasonography and magnetic resonance imaging in the evaluation of tendino-ligamentous injuries around ankle joint.Egypt J Radiol Nuclear Med. 2016; 47: 543-555
- Value of ultrasonography for detecting chronic injury of the lateral ligaments of the ankle joint compared with ultrasonography findings.Br J Radiol. 2014; 8720130406
- Diagnostic performance of ankle ultrasound for diagnosing anterior talofibular and calcaneofibular ligament injuries: a meta-analysis.Acta Radiol. 2020; 61: 651-661
- High resolution ultrasonography in ankle joint pain: where does it stand?.Egypt J Radiol Nuclear Med. 2017; 48: 645-652
- Comparative assessment of the acute ankle injury by ultrasound and magnetic resonance.Coll Antropol. 2012; 36: 605-610
- BET 2: Diagnostic value of ultrasound in determining lateral ligament injury of the ankle.Emergency Med J. 2019; 36: 56-57
- Articular mobility in an African population.Ann Rheum Dis. 1973; 32: 413
- Musculoskeletal ultrasound: technical guidelines.Insights Imaging. 2010; 1: 99-141
- Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus.Eur Radiol. 2018; 28: 5338-5351
- The diagnostic value of high-resolution ultrasound in evaluation of ankle sports injuries: a comparative study with MRI.Egypt J Hosp Med. 2020; 81: 1209-1216
- Dynamic high-resolution ultrasound in the diagnosis of calcaneofibular ligament injury in chronic lateral ankle injury: a comparison with three-dimensional magnetic resonance imaging.J Med Ultrason (2001). 2020; 47: 313-317
- The manual stress test may not be sufficient to differentiate ankle ligament injuries.Clin Biomech (Bristol, Avon). 2000; 15: 619-623
- The value of ultrasound in acute ankle injury: comparison with MR.Eur J Trauma Emerg Surg. 2009; 35: 141-146
- Dynamic high-resolution US of ankle and midfoot ligaments: normal anatomic structure and imaging technique.Radiographics. 2015; 35: 164-178
- Ultrasonography of capsular morphology in normal and traumatic ankle joints.J Clin Ultrasound. 1993; 21: 179-187
- Bedside ultrasonography by emergency physicians for anterior talofibular ligament injury.J Emerg Trauma Shock. 2013; 6: 195-198
- Ultrasound examination for the diagnosis of chronic anterior talofibular ligament injury.Acta Radiol. 2012; 53: 1142-1145
- Accuracy of point-of-care ultrasonography for pediatric ankle sprain injuries.Pediatr Emerg Care. 2018; 34: 842-847
- The feasibility of point-of-care ankle ultrasound examination in patients with recurrent ankle sprain and chronic ankle instability: comparison with magnetic resonance imaging.Injury. 2017; 48: 2323-2328
- Lateral ankle ligaments and tibiofibular syndesmosis. 13-MHz high-frequency sonography and MRI compared in 20 patients.Acta Orthop Scand. 1998; 69: 51-55
- Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging.Skelet Radiol. 2008; 37: 209-216
- Ultrasonographic assessment of deltoid ligament integrity in ankle fractures.Foot Ankle Int. 2020; 41: 147-153
- Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.Orthopedics. 2011; 34: e639-e643
- Talocrural and subtalar joint instability after lateral ankle sprain.Med Sci Sports Exerc. 1999; 31: 1501-1508
- Arthrography, clinical examination, and stress radiograph in the diagnosis of acute injury to the lateral ligaments of the ankle.Am J Sports Med. 1992; 20: 2-6
- Deltoid ligament abnormalities in chronic lateral ankle instability.Foot Ankle Int. 2011; 32: 873-878
- Normal and injured ankle ligaments on ultrasonography with magnetic resonance imaging correlation.J Ultrasound Med. 2019; 38: 513-528
- A comparative study on the influence of probe placement on quality assurance measurements in B-mode ultrasound by means of ultrasound phantoms.Open Biomed Eng J. 2015; 9: 164-178
- Diagnosis of lateral ankle ligament injuries: comparison between talar tilt, MRI and operative findings in 112 athletes.Acta Orthop Scand. 1997; 68: 286-290
- Diagnostic accuracy of instrumented and manual talar tilt tests in chronic ankle instability populations.Scand J Med Sci Sports. 2015; 25: e214-e221
Article info
Publication history
Published online: August 20, 2021
Footnotes
Financial Disclosure: None reported.
Conflicts of Interest: None reported.
Identification
Copyright
© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.
