Fibular ligament lesions-reliable ultrasound diagnostics : Tricks and tips

Abstract

In 2020 a total of 126patients attended the practice with distortion trauma of the ankle. Based on athorough clinical and ultrasound examination 25ligamentous injuries of the anterior talofibular ligament (ATFL, 9.8%), 8osseous ligament avulsions (6.3%), 7injuries of the lateral calcaneocuboid ligament (CC ligament, 5.6%), 5lesions of the calcaneofibular ligament (CFL) each combined with ATFL injuries (3.9%) and 1syndesmosis injury (0.6%) were recorded. This didactic article presents acomprehensible ultrasound examination course in an instructive manner from the clinical practice. Identification of osseous and ligamentous landmarks is often difficult clinically and even in an anatomical preparation but it can easily be done using ultrasound. Hemarthrosis of the ankle has a high predictive value with respect to an associated ligament tear and is easily detectable by ultrasound. Injuries of the ATFL, the anterior syndesmosis and damage to the lateral malleolar epiphysis can easily be clearly distinguished sonographically. Apositive decompression test confirms the distal avulsion of the ATFL. Sonographic stability testing of the AFTL can be carried out immediately after the clinical examination in the same position and visualized on the monitor. The talofibular advance can be measured on the monitor. Instability of the anterior syndesmosis can be visually demonstrated on the monitor using the sonographic Frick test. Afinal ultrasound control on the monitor confirms the structural healing and the re-establishment of ligamentous stability.