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Colò G, Bignotti B, Costa G, Signori A, Tagliafico AS. Ultrasound or MRI in the Evaluation of Anterior Talofibular Ligament (ATFL) Injuries: Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:2324. [PMID: 37510068 PMCID: PMC10378286 DOI: 10.3390/diagnostics13142324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES Ankle sprains represent the second most common cause of emergency department access for musculoskeletal injury and lateral ankle ligament complex tears account for 850,000 cases annually in the United States with a relapse rate of 70%. Clinical examination is limited due to its subjectivity and the difficulty of identifying a specific involvement of the ligament; therefore, US and MRI are frequently requested. Therefore, the goal of this study is to analyze the available literature on the use of ultrasound (US) and magnetic resonance imaging (MRI) to diagnose injuries to the anterior talofibular ligament (ATFL) with a meta-analytic approach. METHODS According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, all studies regarding the diagnostic accuracy of ultrasound and magnetic resonance imaging ATFL injuries were searched and assessed. The data were obtained from two independent reviewers with 12 and 3 years of experience in meta-analysis. A QUADAS-2 (Quality Assessment of Studies of Diagnostic Accuracy Studies) checklist was carried out to assess the risk of biases. From the selected studies, the sensitivity, specificity, and accuracy data were extracted. RESULTS Nine studies were included. The results of the meta-analysis demonstrate a greater sensitivity for ultrasound [96.88 (95% CI: 94-99) (fixed effects); 97 (95% CI: 94-99) (random effects)] compared to MRI [88.50 (95% CI: 85-91) (fixed effects); 86.98 (95% CI: 77-94) (random effects)], p < 0.05. The result of this meta-analysis shows that the less expensive diagnostic technique is also the most sensitive for the diagnosis of ATFL tears. Ultrasound articles resulted to have non-heterogeneity [(p = 0.2816; I° = 21.4607%)]. CONCLUSION This meta-analysis demonstrates that US appears to be a highly sensitive diagnostic technique for diagnosing tears of the ATFL. Compared to MRI, the sensitivity of US result was higher.
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Affiliation(s)
- Gabriele Colò
- Orthopedic Section, National Hospital of SS. Antonio and Biagio and C. Arrigo, 15121 Alessandria, Italy
| | - Bianca Bignotti
- Department of Radiology, IRCCS-Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Giacomo Costa
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, 16126 Genova, Italy
| | - Alessio Signori
- Biostatistics Section, Department of Health Sciences (DISSAL), University of Genova, 16126 Genova, Italy
| | - Alberto Stefano Tagliafico
- Department of Radiology, IRCCS-Ospedale Policlinico San Martino, 16132 Genova, Italy
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, 16126 Genova, Italy
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Tarczyńska M, Sekuła P, Gawęda K, Szubstarski M, Przybylski P, Czekajska-Chehab E. Stress radiography in the diagnosis and assessment of the outcomes of surgical treatment of chronic anterolateral ankle instability. Acta Radiol 2020; 61:783-788. [PMID: 31744302 DOI: 10.1177/0284185119882661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In about 20-40% of patients, damage to the soft tissues surrounding the ankle leads to recurrent and chronic pain with signs of instability of the talus in the tibiofibular fork. PURPOSE The aim of the study was to assess the usefulness of stress X-ray images in the diagnosis of long-term outcomes of conservative versus surgical treatment of anterolateral ankle instability. MATERIAL AND METHODS Thirty patients with chronic ankle instability (CAI) were recruited for the study. The participants were divided into two groups. The first group consisted of 15 non-operatively treated individuals diagnosed with anterior talofibular ligament (ATFL) damage. The second group consisted of 15 patients who had undergone surgical reconstruction of the ATFL. In both groups of patients, the contralateral normal limb was used as a control. In all patients, anteroposterior and lateral view stress radiographs of both ankles were taken using the TELOS Stress Device (GA - III/E, Hungen, Germany). RESULTS Statistical tests showed that the surgically treated patients had a significantly greater ankle stability compared to the non-surgically treated patients (P = 0.001 for talar tilt angle and P = 0.009 for anterior drawer distance). The results obtained in this study indicate that this method can also be used in postoperative assessment of the function of the reconstructed lateral ankle ligaments. CONCLUSIONS Stress radiography is a reliable and safe tool for diagnosing CAI. This imaging method is an objective instrument that can be successfully used in postoperative assessment of the function of the reconstructed ATFL.
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Affiliation(s)
- Marta Tarczyńska
- Department and Clinic of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Sekuła
- Department and Clinic of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Gawęda
- Department and Clinic of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - Mateusz Szubstarski
- Department and Clinic of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - Piotr Przybylski
- 1st Department of Medical Radiology, Medical University of Lublin, Lublin, Poland
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Kikumoto T, Akatsuka K, Nakamura E, Ito W, Hirabayashi R, Edama M. Quantitative evaluation method for clarifying ankle plantar flexion angles using anterior drawer and inversion stress tests: a cross-sectional study. J Foot Ankle Res 2019; 12:27. [PMID: 31073333 PMCID: PMC6500013 DOI: 10.1186/s13047-019-0337-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/18/2019] [Indexed: 12/26/2022] Open
Abstract
Background Chronic ankle instability (CAI) may result from repeated, frequent ankle sprains during sports activities. Manual examination for CAI is conducted; however, quantitative methods for the evaluation of CAI have not been established, and the reproducibility of the amount of stress is low. This cross-sectional study aimed to use a stress device and ultrasound for the quantitative evaluation of the change in the length of the anterior talofibular ligament (ATFL) during simulated anterior drawer and ankle inversion stress tests. Methods Questionnaires were provided to 160 healthy college students (86 men, 74 women; 320 ankles). We extracted two groups from them: control subjects without a history of ankle injury (n = 64 ankles) and subjects with CAI (n = 54 ankles). We calculated the change in the length of the ATFL with anterior drawer and inversion stress tests at ankle joint plantar flexions of 0°, 20°, and 45° using ultrasound images. Results The anterior length change rates were significantly higher in the CAI group than in the control group at ankle joint plantar flexions of 20° and 45° in men (P < 0.05). The inversion length change rates were significantly higher in the CAI group at ankle joint plantar flexion of 20° in men (P < 0.05). No significant between-group difference in the anterior and inversion length change rates was observed in women. Conclusions Stress ultrasound revealed greater length changes in the ATFL in the CAI group than in the control group. The stress test may be useful at ankle joint plantar flexion of 20° for men.
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Affiliation(s)
- Takanori Kikumoto
- 1Institute for Human Movement and Medical Sciences, Physical Therapy Department, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata, 950-3198 Japan
| | - Kazuma Akatsuka
- Johto Orthopaedic Clinic, 6-7-6 Higashidori, Akita-shi, Akita, 010-0003 Japan
| | - Emi Nakamura
- 1Institute for Human Movement and Medical Sciences, Physical Therapy Department, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata, 950-3198 Japan
| | - Wataru Ito
- 1Institute for Human Movement and Medical Sciences, Physical Therapy Department, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata, 950-3198 Japan
| | - Ryo Hirabayashi
- 1Institute for Human Movement and Medical Sciences, Physical Therapy Department, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata, 950-3198 Japan
| | - Mutsuaki Edama
- 1Institute for Human Movement and Medical Sciences, Physical Therapy Department, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, Niigata, 950-3198 Japan
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Abdeen R, Comfort P, Starbuck C, Nester C. Ultrasound Characteristics of Foot and Ankle Structures in Healthy, Coper, and Chronically Unstable Ankles. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:917-926. [PMID: 30208221 DOI: 10.1002/jum.14770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Ankle sprains constitute approximately 85% of all ankle injuries, and up to 70% of people experience residual symptoms. While the injury to ligaments is well understood, the potential role of other foot and ankle structures has not been explored. The objective was to characterize and compare selected ankle structures in participants with and without a history of lateral ankle sprain. METHODS A total of 71 participants were divided into 31 healthy, 20 coper, and 20 chronic ankle instability groups. Ultrasound images of the anterior talofibular and calcaneofibular ligaments, fibularis tendons and muscles, tibialis posterior, and Achilles tendon were obtained. Thickness, length, and cross-sectional areas were measured and compared among groups. RESULTS When under tension, the anterior talofibular ligament (ATFL) was longer in copers and chronic ankle instability groups compared to healthy participants (P < .001 and P = .001, respectively). The chronic ankle instability group had the thickest ATFL and calcaneofibular ligament among the 3 groups (p < 0.001). No significant differences (P > .05) in tendons and muscles were observed among the 3 groups. CONCLUSIONS The ultrasound protocol proved reliable and was used to evaluate the length, thickness, and cross-sectional areas of selected ankle structures. The length of the ATFL and the thickness of the ATFL and calcaneofibular ligament were longer and thicker in injured groups compared to healthy.
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Affiliation(s)
- Rawan Abdeen
- School of Health Sciences, University of Salford, Salford, UK
| | - Paul Comfort
- School of Health Sciences, University of Salford, Salford, UK
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Elkaïm M, Thès A, Lopes R, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Boniface O, Guillo S, Bauer T. Agreement between arthroscopic and imaging study findings in chronic anterior talo-fibular ligament injuries. Orthop Traumatol Surg Res 2018; 104:S213-S218. [PMID: 30268650 DOI: 10.1016/j.otsr.2018.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 09/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Imaging studies done to evaluate chronic ankle instability (CAI) often fail to accurately detail injuries to the anterior talo-fibular ligament (ATFL) and may, therefore, also fail to provide guidance for selecting the most appropriate surgical procedure. Arthroscopy is now an indispensable tool for accurately diagnosing ATFL injuries. This study looked at agreement between arthroscopy and imaging study assessments of ATFL injuries. The primary objective was to adapt an arthroscopic classification of chronic ATFL lesions to the pre-operative imaging study findings in order to estimate the performance of computed tomography (CT)-arthrography, ultrasonography, and magnetic resonance imaging (MRI) in diagnosing ATFL lesions, using arthroscopy as the reference standard. HYPOTHESIS Agreement between arthroscopic and imaging findings of chronic ATFL injuries can be assessed by using a shared classification developed from the arthroscopic evaluation, used as the reference standard. MATERIAL AND METHODS A prospective multicentre study was conducted in 286 patients with arthroscopically-treated CAI. In each patient, the arthroscopic assessment of the ATFL was compared to the pre-operative findings by CT-arthrography, ultrasonography, and MRI. A classification of ATFL lesions based on the arthroscopic assessment was used to analyse the imaging studies. Using this classification, two independent observers compared the findings and evaluated the agreement between arthroscopy and imaging studies. RESULTS Of the 286 patients, 157 had complete information on the arthroscopic assessment and on pre-operative imaging studies and were included in the analysis. Imaging studies were CT-arthrography in 49 patients, ultrasonography in 63 patients, and MRI in 45 patients; both ultrasonography and MRI were performed in 3 patients. Agreement with arthroscopy was 82% and 88.5% for CT-arthrography, 66.7% and 76.2% for ultrasonography, 70.5% and 79.5% for MRI, and 73.4% and 81.2% for all imaging studies pooled. DISCUSSION Arthroscopy plays a crucial role in the definitive assessment of ligament lesions in patients with CAI, as it supplies far more accurate information than any of the current imaging studies and, in addition, provides a dynamic evaluation of the ligaments and assesses mechanical strength. In the study population, a simple arthroscopic evaluation consistently visualised ATFL lesions, thereby either correcting or confirming the pre-operative imaging study findings. Importantly, the arthroscopic assessment provided more accurate information on the lesions and quality of the ATFL compared to the imaging studies. Arthroscopy has improved our knowledge of chronic ATFL lesions and allowed the development of a simple but accurate four-grade classification of direct relevance to choosing the optimal therapeutic procedure. This classification must be disseminated among radiologists to improve the diagnostic performance of pre-operative imaging studies, assist surgeons in selecting the most appropriate ankle-stabilising procedure, and improve patient information. Further studies are needed to confirm the promising results reported here and the usefulness of this common arthroscopy and imaging-study classification for chronic ATFL lesions. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Marc Elkaïm
- Clinique de Tournan, 2, rue Jules-Lefebvre, 77220 Tournan-en-Brie, France
| | - André Thès
- Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, AP-HP, groupe hospitalier universitaire Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Hôpital privé d'Eure-et-Loir, 2, rue Roland-Buthier, 28300 Mainvilliers, France
| | - Ronny Lopes
- PCNA, polyclinique de l'Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France
| | - Michael Andrieu
- Clinique Pont-de-Chaume, 330, avenue Marcel-Unal, 82000 Montauban, France
| | - Guillaume Cordier
- Clinique du sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - François Molinier
- Clinique des Cèdres, route de Mondonville, 31700 Cornebarrieu, France
| | - Jonathan Benoist
- CHP Saint-Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Fabrice Colin
- Clinique mutualiste catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - Olivier Boniface
- Clinique Générale Annecy, 4, chemin de la Tour-la-Reine, 74000 Annecy, France
| | - Stéphane Guillo
- Clinique du sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Thomas Bauer
- Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, AP-HP, groupe hospitalier universitaire Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Hotfiel T, Heiss R, Janka R, Forst R, Raithel M, Lutter C, Gelse K, Pachowsky M, Golditz T. Acoustic radiation force impulse tissue characterization of the anterior talofibular ligament: a promising noninvasive approach in ankle imaging. PHYSICIAN SPORTSMED 2018; 46:435-440. [PMID: 29886782 DOI: 10.1080/00913847.2018.1484658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The anterior talofibular ligament (ATFL) is the most frequently injured ligament during inversion strains of the ankle. The purpose of this study was to evaluate the feasibility of acoustic radiation force impulse (ARFI) elastography and to determine the in vivo mechanical properties of the ATFL in healthy athletes. METHODS Sixty healthy athletes (32 female, 28 male; 28.9 ± 2.1 years) were recruited from the medical and sports faculty. ARFI values, represented as shear wave velocities (SWVs) as well as conventional ultrasound were obtained for the ATFL in neutral ankle position. A clinical assessment was performed in which the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score and the functional ankle ability measure (FAAM) were collected. Interobserver and intraobserver reliability (repeated sessions and repeated days) were assessed using an intra class correlation coefficient (ICC) and typical error (TE) calculation in absolute (TE) and relative units as coefficient of the variation (CV). RESULTS SWV values of the ATFL had an average velocity of 1.79 ± 0.20 m/s for all participants, with an average of 1.72 ± 0.36 m/s for females and 1.85 ± 0.31 m/s for males. The interobserver and intraobserver reliability revealed an ICC of 0.902 and 0.933 (TE of 0.67 (CV: 5.2%) and 0.52 (CV: 3.84%)), respectively. FAAM and AOFAS revealed the best possible scores. CONCLUSION ARFI seems to be a valuable diagnostic modality and represents a promising imaging marker for the assessment and monitoring of ankle ligaments in the context of acute and chronic ankle instabilities; ARFI could also be used to investigate loading or sport dependent adaptions.
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Affiliation(s)
- Thilo Hotfiel
- a Department of Orthopedic Surgery , Friedrich-Alexander- University Erlangen-Nuremberg , Erlangen , Germany
| | - Rafael Heiss
- b Department of Radiology , University Hospital Erlangen , Erlangen , Germany
| | - Rolf Janka
- b Department of Radiology , University Hospital Erlangen , Erlangen , Germany
| | - Raimund Forst
- a Department of Orthopedic Surgery , Friedrich-Alexander- University Erlangen-Nuremberg , Erlangen , Germany
| | - Martin Raithel
- c Department of Medicine II, Gastroenterology and Interventional Endoscopy , Malteser Waldkrankenhaus St. Marien , Erlangen , Germany
| | - Christoph Lutter
- d Department of Orthopedic and Trauma Surgery, Sportsorthopedics and Sportsmedicine , Klinikum Bamberg , Bamberg , Germany
| | - Kolja Gelse
- e Department of Orthopedic Trauma Surgery , University Hospital Erlangen , Erlangen , Germany
| | - Milena Pachowsky
- e Department of Orthopedic Trauma Surgery , University Hospital Erlangen , Erlangen , Germany
| | - Tobias Golditz
- e Department of Orthopedic Trauma Surgery , University Hospital Erlangen , Erlangen , Germany
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Younan Y, Uriell M, Carpenter W, Umpierrez M, Kakarala A, Jose J, Robertson DD, Subhawong TK, Singer AD. Anatomic Relationship and Imaging Relevance of the Perforating Branches of the Peroneal Vessels to the Anterior Talofibular Ligament. J Emerg Med 2017; 52:707-714. [PMID: 28131608 DOI: 10.1016/j.jemermed.2016.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Patients frequently present to the emergency department after ankle injuries, and the anterior talofibular ligament (ATFL) is commonly damaged. Musculoskeletal ultrasound (US) can help to make a rapid diagnosis. There is a paucity of literature describing techniques to image the ATFL with US, and the complex ankle anatomy and potential pitfalls make imaging challenging. OBJECTIVE Our aim was to estimate prevalence of perforating branches (PBs) of the peroneal vessels and determine their most frequent position relative to the ATFL. If these vessels are located in a predictable position at the level of the ATFL, they may serve as a sonographic landmark for the correct imaging plane. METHODS Magnetic resonance imaging (MRI) scans of 105 ankles were reviewed to determine the PB prevalence and location at the ATFL. Inter-observer agreement was determined. Additionally, 16 ankles from 8 asymptomatic subjects were scanned using a high-frequency linear transducer and PB prevalence and location were noted. RESULTS By MRI, PBs were detected in 85% of the ankles and 93% of ankles after consensus. In 73% of cases with agreed PB visualization, vessels assumed a medial position with respect to the ATFL. By US, PBs could be seen in 100% of cases, with the arterial PB seen in 81% of cases and assuming a medial position in 88%. CONCLUSIONS PBs are often present, have a predictable course, and may be useful to help optimize US probe positioning when assessing the ATFL.
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Affiliation(s)
- Yara Younan
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Matthew Uriell
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Walter Carpenter
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Aparna Kakarala
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Jean Jose
- Department of Radiology, University of Miami, Miami, Florida
| | - Douglas D Robertson
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Ty K Subhawong
- Department of Radiology, University of Miami, Miami, Florida
| | - Adam Daniel Singer
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
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