Abstract
ObjectivesTo 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).MethodsAll 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.ResultsBetween 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).ConclusionsUltrasound 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.
Highlights
Acute ligamentous ankle injuries are one of the most common injuries in sports [1]
Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the anterior inferior tibiofibular ligament (AITFL)
Ankle injuries were excluded if imaging studies demonstrated an ankle fracture or if the ultrasound and magnetic resonance imaging (MRI) studies could not be acquired within 10 days post-injury
Summary
Acute ligamentous ankle injuries are one of the most common injuries in sports [1]. The diagnostic value of ultrasound for acute injury of the anterior talofibular ligament (ATFL) has been investigated in various studies [8]. The diagnostic value of a systematic approach (including the calcaneofibular ligament (CFL) and syndesmosis) to acute ligamentous ankle injuries has only been reported in two studies [9, 10]. The main limitation in these studies is that the diagnostic values were reported for ligamentous injury, without the differentiation between partial and complete tears. As only complete tears are considered amenable to surgical repair, a study investigating the diagnostic value of ultrasound for complete ligamentous discontinuity is warranted [11, 12]
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