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Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries
OBJECTIVES: To determine the diagnostic value of ultrasonography for complete discontinuity of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the anterior inferior tibiofibular ligament (AITFL). METHODS: All acute ankle injuries in adult athletes (> 18 years old)...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979658/ https://www.ncbi.nlm.nih.gov/pubmed/33026501 http://dx.doi.org/10.1007/s00330-020-07305-7 |
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author | Baltes, Thomas P. A. Arnáiz, Javier Geertsema, Liesel Geertsema, Celeste D’Hooghe, Pieter Kerkhoffs, Gino M. M. J. Tol, Johannes L. |
author_facet | Baltes, Thomas P. A. Arnáiz, Javier Geertsema, Liesel Geertsema, Celeste D’Hooghe, Pieter Kerkhoffs, Gino M. M. J. Tol, Johannes L. |
author_sort | Baltes, Thomas P. A. |
collection | PubMed |
description | OBJECTIVES: To determine the diagnostic value of ultrasonography for complete discontinuity of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the anterior inferior tibiofibular ligament (AITFL). METHODS: All acute ankle injuries in adult athletes (> 18 years old) presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital within 7 days post-injury were assessed for eligibility. Using ultrasonography, one musculoskeletal radiologist assessed the ATFL, CFL and AITFL for complete discontinuity. Dynamic ultrasound measurements of the tibiofibular distance (mm) in both ankles (injured and contralateral) were acquired in the neutral position (N), during maximal external rotation (Max ER), and maximal internal rotation (Max IR). MR imaging was used as a reference standard. RESULTS: Between October 2017 and July 2019, 92 acute ankle injuries were included. Ultrasound diagnosed complete discontinuity of the ATFL with 87% (CI 74–95%) sensitivity and 69% (CI 53–82%) specificity. Discontinuity of the CFL was diagnosed with 29% (CI 10–56%) sensitivity and 92% (CI 83–97%) specificity. Ultrasound diagnosed discontinuity of the AITFL with 100% (CI 74–100%) sensitivity and 100% (CI 95–100%) specificity. Of the dynamic measurements, the side-to-side difference in external rotation had the highest diagnostic value for complete discontinuity of the AITFL (sensitivity 82%, specificity 86%; cut-off 0.93 mm). CONCLUSIONS: Ultrasound has a good to excellent diagnostic value for complete discontinuity of the ATFL and AITFL. Therefore, ultrasound can be used to screen for injury of the ATFL and AITFL. Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL. KEY POINTS: • Ultrasound has a good to excellent diagnostic value for complete discontinuity of the anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament (AITFL). • Ultrasound can be used to screen for injury of the ATFL and AITFL. • Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00330-020-07305-7) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7979658 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-79796582021-04-05 Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries Baltes, Thomas P. A. Arnáiz, Javier Geertsema, Liesel Geertsema, Celeste D’Hooghe, Pieter Kerkhoffs, Gino M. M. J. Tol, Johannes L. Eur Radiol Musculoskeletal OBJECTIVES: To determine the diagnostic value of ultrasonography for complete discontinuity of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the anterior inferior tibiofibular ligament (AITFL). METHODS: All acute ankle injuries in adult athletes (> 18 years old) presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital within 7 days post-injury were assessed for eligibility. Using ultrasonography, one musculoskeletal radiologist assessed the ATFL, CFL and AITFL for complete discontinuity. Dynamic ultrasound measurements of the tibiofibular distance (mm) in both ankles (injured and contralateral) were acquired in the neutral position (N), during maximal external rotation (Max ER), and maximal internal rotation (Max IR). MR imaging was used as a reference standard. RESULTS: Between October 2017 and July 2019, 92 acute ankle injuries were included. Ultrasound diagnosed complete discontinuity of the ATFL with 87% (CI 74–95%) sensitivity and 69% (CI 53–82%) specificity. Discontinuity of the CFL was diagnosed with 29% (CI 10–56%) sensitivity and 92% (CI 83–97%) specificity. Ultrasound diagnosed discontinuity of the AITFL with 100% (CI 74–100%) sensitivity and 100% (CI 95–100%) specificity. Of the dynamic measurements, the side-to-side difference in external rotation had the highest diagnostic value for complete discontinuity of the AITFL (sensitivity 82%, specificity 86%; cut-off 0.93 mm). CONCLUSIONS: Ultrasound has a good to excellent diagnostic value for complete discontinuity of the ATFL and AITFL. Therefore, ultrasound can be used to screen for injury of the ATFL and AITFL. Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL. KEY POINTS: • Ultrasound has a good to excellent diagnostic value for complete discontinuity of the anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament (AITFL). • Ultrasound can be used to screen for injury of the ATFL and AITFL. • Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00330-020-07305-7) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-10-07 2021 /pmc/articles/PMC7979658/ /pubmed/33026501 http://dx.doi.org/10.1007/s00330-020-07305-7 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Musculoskeletal Baltes, Thomas P. A. Arnáiz, Javier Geertsema, Liesel Geertsema, Celeste D’Hooghe, Pieter Kerkhoffs, Gino M. M. J. Tol, Johannes L. Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries |
title | Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries |
title_full | Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries |
title_fullStr | Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries |
title_full_unstemmed | Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries |
title_short | Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries |
title_sort | diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries |
topic | Musculoskeletal |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979658/ https://www.ncbi.nlm.nih.gov/pubmed/33026501 http://dx.doi.org/10.1007/s00330-020-07305-7 |
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