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Omodani T, Takahashi K. Ultrasound findings of the deltoid ligament in patients with acute ankle sprains: A retrospective review. J Orthop Sci 2022:S0949-2658(22)00130-0. [PMID: 35691876 DOI: 10.1016/j.jos.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The deltoid ligament is a complex structure composed of multiple ligaments located on the medial side of the ankle joint that can be injured by ankle sprains. Although there have been previous reports on ultrasound imaging of the injured deltoid ligament, a systematic method for depicting each ligament component has not been established. This study aimed to clarify the ultrasound findings of the deltoid ligament in ankle sprains using a systematic scanning protocol. METHODS We examined the tenderness of the medial ankle and evaluated the ultrasound findings of the deltoid ligament in 169 sprained ankles with no fracture, within 3 days after injury. Observation and evaluation of the six components of the deltoid ligament were performed using a systematic scanning protocol with four probe positions. RESULTS Of the 169 ankles, 48 ankles had tenderness in the deltoid ligament. Ultrasonography confirmed deltoid ligament damage in 13 of these 48 ankles. Of the 13 ankles, 3 ankles had damages only in the superficial layer, 3 ankles only in the deep layer, and 7 ankles in both the superficial and deep layers. CONCLUSIONS We clarified the details of the damage pattern of the deltoid ligament in acute ankle sprains. It was possible to identify the superficial and deep layers of the ligament and to observe the damage pattern of each ligament component in detail, and it appeared that ultrasonography could be used as a tool to evaluate the damage pattern of the deltoid ligament in acute ankle sprains.
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Affiliation(s)
- Toru Omodani
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833, Hasama-cho, Funabashi, Chiba Prefecture 2740822, Japan; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | - Kenji Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833, Hasama-cho, Funabashi, Chiba Prefecture 2740822, Japan
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2
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Nevalainen MT, Pitkänen MM, Saarakkala S. Diagnostic Performance of Ultrasonography for Evaluation of Osteoarthritis of Ankle Joint: Comparison With Radiography, Cone-Beam CT, and Symptoms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1139-1146. [PMID: 34378811 DOI: 10.1002/jum.15803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/09/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To determine the diagnostic performance of ultrasonography (US) for evaluation of the ankle joint osteoarthritic (OA) changes. Cone-beam computed tomography (CT) was used as the gold standard and US performance was compared with conventional radiography (CR). As a secondary aim, associations between the imaging findings and ankle symptoms were assessed. METHODS US was performed to 51 patients with ankle OA. Every patient had prior ankle CR and underwent cone-beam CT during the same day as US examination. On US, effusion/synovitis, osteophytes, talar cartilage damage, and tenosynovitis were evaluated. Comparison to respective imaging findings on CR and cone-beam CT was then performed. Single radiologist blinded to other modalities assessed all the imaging studies. Symptoms questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), was available for 48 patients. RESULTS US detected effusion/synovitis of the talocrural joint with 45% sensitivity and 90% specificity. For the detection of anterior talocrural osteophytes, US sensitivity was 78% and specificity 79%. For the medial talocrural osteophytes, they were 39 and 83%, and for the lateral talocrural osteophytes 54 and 100%, respectively. Considering cartilage damage of the talus, US yielded a low sensitivity of 18% and high specificity of 97%. Overall, the performance of US was only moderate and comparable to CR. The imaging findings showed only weak associations with ankle symptoms. CONCLUSIONS The ability of US to detect ankle OA is only moderate. Interestingly, performance of CR also remained moderate. The associations between imaging findings and WOMAC score seem to be weak in ankle OA.
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Affiliation(s)
- Mika T Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu
- Medical Research Center Oulu, University of Oulu, Oulu
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu
| | | | - Simo Saarakkala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu
- Medical Research Center Oulu, University of Oulu, Oulu
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu
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3
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Ma Z, Feng W, Duan X, Chen X, Qiao G, Liu Z. Effects of full-threaded headless cannulated compression screws and anatomical plates on the efficacy, safety, and prognosis of patients with triplane fractures of the distal tibia. Am J Transl Res 2022; 14:1714-1720. [PMID: 35422918 PMCID: PMC8991173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the clinical efficacy, safety, and prognosis of full-threaded headless cannulated compression screws (HCCSs) and anatomical plates (APs) in the treatment of triplane fractures of the distal tibia. METHODS In this retrospective study, 74 patients with triplane fractures of the distal tibia treated in our hospital from April 2017 to March 2019 were selected as the research subjects. Among them, 38 patients receiving full-threaded HCCSs were assigned to the research group (RG), and the remaining 36 patients receiving APs were assigned to the control group (CG). The general indices, including operation, fracture healing, and ambulation times, efficacy, and complications were recorded and compared between the two groups. Visual analogue scale (VAS) was applied to assess pain, and a quality of life (QOL) survey was conducted at 6 months after surgery. RESULTS Compared with the CG, the operation time, fracture healing time, and ambulation time of the RG were significantly shortened (P<0.05). The proportion of patients with excellent and good outcomes and Mazur Scores in the RG were higher than those in the CG (P<0.05). The frequency of complications in the RG was lower than that in the CG (P<0.05). The preoperative VAS score did not exhibit significant differences between the two groups (P<0.05), but the scores in the RG at T1 and T2 were significantly lower than those in the CG (P<0.001). The QOL score in the RG (76.17±8.57) was also significantly higher than in the CG (71.54±8.02) (P<0.05). CONCLUSION Full-threaded HCCSs are more effective and safer than APs and can effectively improve the prognosis of patients with triplane fractures of the distal tibia.
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Affiliation(s)
- Zhilin Ma
- Department of Orthopedics II, Affiliated Hospital of Hebei University of EngineeringHandan 056002, Hebei Province, China
| | - Wenfang Feng
- Pre-hospital Emergency, Handan Central HospitalHandan 056001, Hebei Province, China
| | - Xiaowei Duan
- Department of Neurological Surgery, Handan Central HospitalHandan 056001, Hebei Province, China
| | - Xinzhi Chen
- Department of Orthopedics II, Affiliated Hospital of Hebei University of EngineeringHandan 056002, Hebei Province, China
| | - Guoyong Qiao
- Department of Orthopedics II, Affiliated Hospital of Hebei University of EngineeringHandan 056002, Hebei Province, China
| | - Zhiping Liu
- Department of Orthopedics II, Affiliated Hospital of Hebei University of EngineeringHandan 056002, Hebei Province, China
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4
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Kim YH, Chai JW, Kim DH, Kim HJ, Seo J. A problem-based approach in musculoskeletal ultrasonography: heel pain in adults. Ultrasonography 2021; 41:34-52. [PMID: 34674456 PMCID: PMC8696136 DOI: 10.14366/usg.21069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Musculoskeletal ultrasonography (US) has unique advantages, such as excellent spatial resolution for superficial structures, the capability for dynamic imaging, and the ability for direct correlation and provocation of symptoms. For these reasons, US is increasingly used to evaluate problems in small joints, such as the foot and ankle. However, it is almost impossible to evaluate every anatomic structure within a limited time. Therefore, US examinations can be faster and more efficient if radiologists know where to look and image patients with typical symptoms. In this review, common etiologies of heel pain are discussed in a problem-based manner. Knowing the common pain sources and being familiar with their US findings will help radiologists to perform accurate and effective US examinations.
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Affiliation(s)
- Yong Hee Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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5
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Machado M, Amado P, Babulal J. Ankle instability – review and new trends. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211035552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Ankle instability is an old topic with increasing importance in Orthopaedics’ world, as we start now realising how underdiagnosed this pathology has been. A lot of effort has been made in recent years to better understand the pathomechanics of this injury, with new surgical techniques being tried and even new anatomic structures being described. The objective of this paper is to review and compile the most important and recent literature on this matter, in an academic way, but oriented to clinical practice, so it can help surgeons keep updated in this so important subject.
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Affiliation(s)
- Marino Machado
- Orthopaedics Department, Centro Hospitalar de Lisboa Central EPE, Portugal
| | - Paulo Amado
- Unidade de Medicina Desportiva e Artroscopia Avançada,
Hospital Lusíadas Porto, Portugal
| | - Jaime Babulal
- Unidade de Medicina Desportiva e Artroscopia Avançada,
Hospital Lusíadas Porto, Portugal
- Serviço de Ortopedia, Centro Hospitalar do Médio Ave
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Esmailian M, Ataie M, Ahmadi O, Rastegar S, Adibi A. Sensitivity and specificity of ultrasound in the diagnosis of traumatic ankle injury. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:14. [PMID: 34084193 PMCID: PMC8106407 DOI: 10.4103/jrms.jrms_264_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/26/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022]
Abstract
Background: This study was performed to determine the sensitivity and specificity of ultrasound in the diagnosis of traumatic ankle injury in comparison with magnetic resonance imaging (MRI). Materials and Methods: This cross-sectional study was performed on 31 patients with soft-tissue injury or fracture, referring to the MRI imaging center of Alzahra and Kashani Hospitals in Isfahan from October 2018 to March 2019. After an MRI, an ultrasound of the affected ankle was performed for all patients. Sonography and MRI were performed by two radiologists who were blinded to the results of each other's reports. The sensitivity, specificity, positive predictive value, and negative predictive value of sonography were determined. Results: In this study, 31 patients with ankle trauma were studied. The mean age of the patients was 30.73 ± 10.15 years; 32.3% were male and 67.7% were female. The sensitivity of ultrasound relative to MRI to detect damage to the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and calcaneofibular ligament (CFL) was 66.67%, 50%, and 100%, respectively, and the corresponding specificity was 92.86%, 93.10%, and 93.10%, respectively. According to Kappa test, the agreement between ultrasound and MRI methods for detecting injury to ATFL (κ = 0.51), PTFL (κ = 0.35), and CFL (κ= 0.63) was statistically significant (P < 0.05). Conclusion: Ultrasound is an appropriate modality for the diagnosis of injuries to CFL and ATFL and has shown acceptable results for PTFL. It could be used as an alternative in cases where access to MRI is not available.
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Affiliation(s)
- Mehrdad Esmailian
- Department of Emergency Medicine, Emergency Medicine Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Ataie
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Ahmadi
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirvan Rastegar
- Department of Orthopedics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atoosa Adibi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
Although far less common than lateral ankle injuries, medial ankle sprains have been reported to result in significantly greater time lost and long-term disability when not diagnosed and treated accurately. Adequate diagnosis is paramount and the most important aspect is to determine whether the lesion is stable or unstable. Evidence confronting surgical versus conservative treatment in acute deltoid ligament lesions is largely anchored in the setting of ankle fractures. Ultimately treatment decisions rely on the clinical and imaging appraisal of each individual patient. This article discusses the isolated acute deltoid ligament impairment.
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Affiliation(s)
- Gastón Slullitel
- Foot and Ankle Surgery Department, J Slullitel Institute of Orthopaedics, San Luis 2534, Rosario, Santa Fe 2000, Argentina.
| | - Juan Pablo Calvi
- Foot and Ankle Surgery Department, J Slullitel Institute of Orthopaedics, San Luis 2534, Rosario, Santa Fe 2000, Argentina. https://twitter.com/pieijs
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Noda Y, Horibe S, Hiramatsu K, Takao R, Fujita K. Quick and simple test to evaluate severity of acute lateral ankle sprain. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 25:30-34. [PMID: 34141593 PMCID: PMC8180947 DOI: 10.1016/j.asmart.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 12/26/2022]
Abstract
Background/objective For early return to sports after a lateral ankle sprain (LAS) and recurrence prevention, effective rehabilitation and gradual return to sports should be initiated while predicting the return time based on the appropriate severity evaluation immediately after injury. However, since severity evaluations performed in previous studies required large space and stairs and involved high-revel activity, their use as a test and index to evaluate severity after LAS was not appropriate considering convenience and risk of re-injury. Therefore, a quick and simple test was developed to evaluate the severity of acute LAS. This study aimed to verify the association between ankle function for severity evaluation and anterior talofibular ligament (ATFL) injury type by ultrasonography and to clarify the usefulness for acute LAS severity evaluation of the single-leg loading (SLL) test. Methods In total, 50 patients (34 men, 16 women) out of 58 patients who visited our sports clinic within 3 days after acute LAS and who conformed to the study criteria were included in this study. During the first visit, SLL test and objective/subjective ankle joint evaluation were performed. The SLL test consists of single-leg standing, single-leg heel raising and single-leg hopping, and patients were classified into four levels from 1 to 4 according to results. In addition, ultrasonographic evaluation was performed within 1 week after the first visit to evaluate the type of ATFL injury. Type I was defined as intact ATFL, Type II as swollen ATFL with an almost intact fibrillar pattern and Type III as ATFL appearing swollen with a disrupted fibrillar pattern. The relationship between the SLL test and each evaluation item was investigated using Spearman's correlation coefficient. Results As a result of the SLL test, 15 patients had Level 1 (30%), 19 Level 2 (38%), 5 Level 3 (10%) and 11 Level 4 (22%). With regard to correlation coefficients of the SLL test, Japanese Society for Surgery of the Foot ankle/hindfoot scale and sports activity were rs = 0.71 (p < 0.001) and rs = 0.66 (p < 0.001), respectively, showing a significant positive correlation. SLL test and the type of ATFL injury also showed a significant negative correlation (rs = −0.58, p < 0.001). Conclusions The SLL test was a simple and useful test that can be used as an index to evaluate the severity of acute LAS.
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Affiliation(s)
- Yuki Noda
- Department of Rehabilitation, Naragakuen University, Japan
| | - Shuji Horibe
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Japan
| | | | - Rikio Takao
- Graduate School of Life and Environmental Sciences, Osaka Prefecture Univercity, Japan
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9
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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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Advanced Ankle and Foot Sonoanatomy: Imaging Beyond the Basics. Diagnostics (Basel) 2020; 10:diagnostics10030160. [PMID: 32183398 PMCID: PMC7151198 DOI: 10.3390/diagnostics10030160] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022] Open
Abstract
Ankle/foot pain is a common complaint encountered in clinical practice. Currently, due to the complex anatomy, the diagnosis and management of the underlying musculoskeletal disorders are extremely challenging. Nowadays, high-resolution ultrasound has emerged as the first-line tool to evaluate musculoskeletal disorders. There have been several existing protocols describing the fundamental sonoanatomy of ankle/foot joints. However, there are certain anatomic structures (e.g., Lisfranc ligament complex or Baxter nerve) which are also clinically important. As they are rarely elaborated in the available literature, a comprehensive review is necessary. In this regard, the present article aims to brief the regional anatomy, illustrate the scanning techniques, and emphasize the clinical relevance of the ankle/foot region.
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Abstract
Foot and ankle injuries account for a significant volume of primary care office visits each year. Given the incidence of injury and concern for long-term sequelae, it is imperative that primary care physicians familiarize themselves with commonly encountered foot and ankle injuries. Coupling a sound understanding of key anatomic structures with an appropriately gathered history can help to quickly narrow the differential diagnosis in this clinical presentation. This article focuses on key elements from the history and physical examination as well as provides a concise review of imaging modalities and recommended treatment strategies.
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12
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Rosa I, Rodeia J, Fernandes PX, Teixeira R, Saldanha T, Consciência JG. Ultrasonographic Assessment of Deltoid Ligament Integrity in Ankle Fractures. Foot Ankle Int 2020; 41:147-153. [PMID: 31597464 DOI: 10.1177/1071100719882679] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Regardless of fibular status, the presence of a superficial deltoid ligament disruption or a combination of deep and superficial deltoid ligament disruption is central to the decision-making process in treating ankle fractures. The aims of the present study were to test whether ultrasonography can assess deltoid ligament integrity and to determine its validity and reliability by comparing it with gravity stress radiography. METHODS A consecutive series of 81 eligible patients with a nondisplaced or minimally displaced fibula fracture identified on a standard radiograph were prospectively enrolled. All patients underwent gravity stress radiography and ultrasonography. Image analysis included the layer type, integrity, and tear site of the deltoid ligament. Ultrasound validity and intra- and interobserver reliability were assessed by the interpretations of the first author and an independent observer who were blinded to the results. RESULTS Of all patients, 64 (79.0%) had a deltoid ligament disruption; most of the tears were of both the superficial and deep layers, partial and proximal attachment tears, and only 8 (12.5%) were complete tears. Patients with an intact deltoid ligament had a mean medial clear space (MCS) value of 2.7 ± 0.5 mm, and those with deltoid ligament tears had a mean MCS value of 5.9 ± 3.4 mm (P < .001). In a comparison between ultrasonography and gravity radiography, we found a sensitivity of 100% versus 97%, a specificity of 90% versus 100%, a positive predictive value of 97% versus 100%, and a negative predictive value of 100% versus 90%, respectively. The intra- and interobserver reliability was evaluated as almost perfect in all conditions. In a comparison between ultrasonography and gravity radiography, we found a sensitivity of 100% versus 97%, a specificity of 90% versus 100%, a positive predictive value of 97% versus 100%, and a negative predictive value of 100% versus 90%, respectively. CONCLUSION Ultrasonography proved to be an accurate tool, allowing the identification of deltoid ligament disruption and the involved components in a more dynamic fashion. Its relative ease of use and lack of ionizing radiation make it a useful and confident technique that can be performed by an orthopedist. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Isabel Rosa
- Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal.,NOVA Medical School/Faculty of Medical Sciences, Lisbon, Portugal
| | - Joaquim Rodeia
- Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | | | | | | | - José Guimarães Consciência
- Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal.,NOVA Medical School/Faculty of Medical Sciences, Lisbon, Portugal
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13
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Dynamic high-resolution ultrasound in the diagnosis of calcaneofibular ligament injury in chronic lateral ankle injury: a comparison with three-dimensional magnetic resonance imaging. J Med Ultrason (2001) 2019; 47:313-317. [PMID: 31823101 DOI: 10.1007/s10396-019-00993-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To date, no gold standard imaging method has been used to assess calcaneofibular ligament (CFL) injuries. Ultrasound (US) has become increasingly important in the assessment of ligaments around the ankle. However, very few reports in the literature have focused on detecting CFL injuries. The objective of this study was to determine the effectiveness of ultrasound in detecting CFL injuries in comparison with magnetic resonance imaging (MRI). METHODS A retrospective study was conducted in 21 patients with chronic lateral ankle injury, 10 males and 11 females with a mean age of 27.6 ± 14.5 years (range 14-68 years). High-frequency US and three-dimensional (3D) MRI of the affected ankle were performed. Evaluations of the CFL were performed by two orthopedic surgeons experienced in US, while the MRI findings were interpreted by two musculoskeletal radiologists. The US findings were then compared with the MRI findings. RESULTS US detected CFL injury in 9/21 patients, and these findings were confirmed by the MRI findings. However, one patient with a normal CFL on US was evaluated as laxity on MRI. In this study, US sensitivity and specificity in detecting CFL injuries was 90% (9/10) and 100% (10/10), respectively, with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 91.7% in comparison with MRI. CONCLUSION With the proper technique and knowledge of the ankle anatomy, high-frequency US proved to be an effective imaging modality in the diagnosis of CFL lesions in chronic lateral ankle injuries. US had a high sensitivity and specificity in the evaluation of the CFL when MRI findings were regarded as the reference standard.
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14
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Singh K, Thukral CL, Gupta K, Singh A. Comparison of high resolution ultrasonography with clinical findings in patients with ankle pain. J Ultrason 2019; 18:316-324. [PMID: 30763016 PMCID: PMC6444321 DOI: 10.15557/jou.2018.0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 11/22/2022] Open
Abstract
Aim: The aim of this study was to investigate the diagnostic accuracy of high resolution ultrasonography for the assessment of painful ankle joint as compared with the clinical findings. Material and Methods: A prospective study was conducted on 136 patients having history of ankle pain and referred to the Department of Radiodiagnosis and Imaging for ultrasonography. Statistical analysis: Comparison of ultrasonography findings and clinical findings was done using McNemar Test. Results: 136 patients with 218 pathologies of the ankle joint were analyzed. Of these, 178 pathologies were clinically suspected, but 206 were diagnosed with ultrasonography. This difference was statistically significant (p value = 0.000). Conclusion: Ultrasonography is an excellent tool for evaluating patients with ankle pain, especially in cases of lateral ligament pathologies, tendinous pathologies, joint effusion, and miscellaneous pathologies. It can be used as the primary imaging investigation because it allows a rapid, dynamic, and cost-effective examination of the ankle joint. However, ultrasonography has limitations when using it to evaluate a suspected posterior talofibular ligament injury, marrow abnormalities, and deep seated pathologies, for which MRI should be incorporated for a diagnosis. Aim: The aim of this study was to investigate the diagnostic accuracy of high resolution ultrasonography for the assessment of painful ankle joint as compared with the clinical findings. Material and Methods: A prospective study was conducted on 136 patients having history of ankle pain and referred to the Department of Radiodiagnosis and Imaging for ultrasonography. Statistical analysis: Comparison of ultrasonography findings and clinical findings was done using McNemar Test. Results: 136 patients with 218 pathologies of the ankle joint were analyzed. Of these, 178 pathologies were clinically suspected, but 206 were diagnosed with ultrasonography. This difference was statistically significant (p value = 0.000). Conclusion: Ultrasonography is an excellent tool for evaluating patients with ankle pain, especially in cases of lateral ligament pathologies, tendinous pathologies, joint effusion, and miscellaneous pathologies. It can be used as the primary imaging investigation because it allows a rapid, dynamic, and cost-effective examination of the ankle joint. However, ultrasonography has limitations when using it to evaluate a suspected posterior talofibular ligament injury, marrow abnormalities, and deep seated pathologies, for which MRI should be incorporated for a diagnosis.
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Affiliation(s)
- Kunwarpal Singh
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
| | - Chuni Lal Thukral
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
| | - Kamlesh Gupta
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
| | - Avtar Singh
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
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Reddy VB, Jones MR, Kaye AD. Ankle Joint. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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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: 5] [Impact Index Per Article: 0.8] [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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Döring S, Provyn S, Marcelis S, Shahabpour M, Boulet C, de Mey J, De Smet A, De Maeseneer M. Ankle and midfoot ligaments: Ultrasound with anatomical correlation: A review. Eur J Radiol 2018; 107:216-226. [PMID: 30173941 DOI: 10.1016/j.ejrad.2018.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/07/2018] [Accepted: 08/11/2018] [Indexed: 02/07/2023]
Abstract
We present a detailed overview of anatomical and US features of ankle and midfoot ligaments based on our own dissections and cadaver studies as well as US imaging in cadavers and volunteers. The ligament anatomy about the ankle and midfoot is complex. Most ligaments are superficial and hence very well accessible for US. US technique to obtain optimal visualization however is difficult and requires a learning curve. We discuss US technique in detail for each individual ligament. We divided the ligaments in different groups: tibiofibular ligaments, Bassett's ligament, lateral collateral ligament complex (anterior talofibular ligament, calcaneofibular ligament, lateral talocalcaneal ligament, posterior talofibular ligament), medial collateral ligament complex, spring ligament, Chopart joint ligaments (bifurcate ligament, dorsal talonavicular ligament, lateral calcaneocuboid ligament, long and short plantar ligaments), Lisfranc ligaments, sinus tarsi ligaments.
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Affiliation(s)
- Seema Döring
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Steven Provyn
- Department of Experimental Anatomy and ARTE, Vrije Universiteit Brussel, Brussel, Belgium
| | - Stefaan Marcelis
- Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Cedric Boulet
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Aron De Smet
- Department of Experimental Anatomy and ARTE, Vrije Universiteit Brussel, Brussel, Belgium
| | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium; Department of Experimental Anatomy and ARTE, Vrije Universiteit Brussel, Brussel, Belgium.
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Abstract
The medial collateral ligament (MCL) complex is characterized by a complex anatomical arrangement of the individual ligamentous structures including three joints and the spring ligament complex. Biomechanically it serves as the main stabilizing structure in the ankle region against rotational and pronating forces. Lesions in the region of the MCL complex are more frequent than previously thought and like lesions of the spring ligament complex can lead to pain and instability. A thorough examination including the patient history with possible injury mechanisms often yields valuable information on the diagnosis of injuries to the MCL or spring ligament complex. In many cases these are primarily overlooked and concomitant lesions, such as fractures, syndesmotic and lateral ligament lesions frequently occur; however, the clinical assessment of stability is often primarily impossible in an acute setting. High-resolution magnetic resonance imaging (MRI) plays a key role in identifying the ligamentous components. In addition, MRI plays a supportive role in the preoperative planning before reconstruction of acute and especially chronic lesions. In most cases the surgical treatment of acute ruptures of the MCL is not indicated. Various options for treatment of acute and chronic lesions of the MCL and spring ligament complex are available including the use of free tendon grafts. Controversy exists regarding the operative treatment of MCL lesions in the case of ankle fractures. It is recommended for cases with impinging tissue in the medial gutter serving as a barrier to adequate reduction of the joint and in cases of unstable fractures after reduction.
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Meyer NB, Jacobson JA, Kalia V, Kim SM. Musculoskeletal ultrasound: athletic injuries of the lower extremity. Ultrasonography 2018; 37:175-189. [PMID: 29794963 PMCID: PMC6044222 DOI: 10.14366/usg.18013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/14/2018] [Indexed: 12/23/2022] Open
Abstract
Athletic injuries of the lower extremities are commonly encountered in clinical practice. While some pathology can be diagnosed on physical exam, others are a clinical dilemma with nonspecific symptomatology. In these situations, ultrasound imaging can be utilized as an exceptional diagnostic tool, offering unique advantages over other imaging modalities. This article will review the imaging characteristics of commonly encountered athletic injuries of the lower extremity.
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Affiliation(s)
- Nathaniel B Meyer
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Vivek Kalia
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Sung Moon Kim
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
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