Abstract
BackgroundThe most common cause of ankle injury is the supination trauma, inflicting a partial or complete rupture of the anterior talofibular ligament (ATFL). Among conventional diagnostic tools and procedures of sports injuries, the method of stress-ultrasonography is reportedly a promising diagnostic tool for examining injuries of the lateral ligaments of the ankle. Preceding studies predominantly examined the comparability of stress-ultrasonography and other established diagnostic tools in terms of efficacy, viability and quality. The purpose of this study was to assess the reliability of stress-ultrasonography of the ATFL based on varying examiner experience and patient positioning.MethodSixteen healthy subjects were examined by four examiners with differing levels of skill and experience in ultrasonography, ranging from laymen to specialist. Measurements were recorded and interrater correlation coefficient (ICC) was applied in four positions, including a neutral position (A), medial rotation (B), plantar flexion (C) and inversion of the foot (D).ResultsThe length of the ATFL was 14.958 ± 2.145 mm in position A, 15.886 ± 1.994 mm in position B, 16.270 ± 1.858 mm in position C and 15.170 ± 1.781 mm in position D. The average length change was 0.928 ± 0.804 mm (6.656 ± 6.299%) in position B, 1.313 ± 1.266 mm (9.746 ± 9.484%) in position C and 0.213 ± 1.807 mm (2.604 ± 12.308%) in position D. The correlation of the combined results of all four investigators was 0.333 for position A, 0.386 for position B, 0.320 for position C and 0.517 for position D. The highest ICC (0.811) was recorded between the orthopedic specialist and the radiology specialist. The lowest ICC (0.299) was recorded between the laymen and the radiology specialist.ConclusionThe reliability of the ATFL examination seems to be exceedingly dependent on the examiner’s experience and skill in ultrasonographic (US) diagnostic. Moreover, the inversion positioning of the foot, described by the European Society of Musculoskeletal Radiology (ESSR) yielded the highest measurement reliability.
Highlights
The most common cause of ankle injury is the supination trauma, inflicting a partial or complete rupture of the anterior talofibular ligament (ATFL)
Ultrasonographic imaging is a valuable diagnostic tool for physicians visualizing the lateral ankle ligaments as it reflects increasing reliability of measurements with examiner experience and skill
Society of Musculoskeletal Radiology seems to be least affected by examiner experience and skill, further deeming this position reliable for ultrasonographic examination
Summary
The most common cause of ankle injury is the supination trauma, inflicting a partial or complete rupture of the anterior talofibular ligament (ATFL). Among conventional diagnostic tools and procedures of sports injuries, the method of stress-ultrasonography is reportedly a promising diagnostic tool for examining injuries of the lateral ligaments of the ankle. Preceding studies predominantly examined the comparability of stress-ultrasonography and other established diagnostic tools in terms of efficacy, viability and quality. Injuries to the ligamentous structures of the ankle joint belong to the most prevalent injuries in sports, with the anterior talofibular ligament (ATFL) being afflicted in 65% of the cases in consequence of supination trauma (Roos et al, 2017). Standard diagnostic methods of lateral ligament injury of the ankle described in the literature include clinical examination, X-ray, magnetic resonance imaging (MRI) and arthrometer stress testing. The available results on this topic stem from different levels of professional examiners with the majority comprised of professional sonographers
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