New sonographically-guided test for anterior knee instability - preliminary report

Ultrasound Imaging of the Anterior Cruciate Ligament: A Pictorial Essay and Narrative Review

Ultrasound has been extensively applied to the diagnosis of and guided interventions for knee disorders. However, although it is commonly affected during sports injuries, the anterior cruciate ligament (ACL) is not usually incorporated in the majority of ultrasound scanning protocols. In the past, because of its oblique trajectory and deeper location, the ACL was considered to be a challenging structure for ultrasound imaging. Owing to advances in ultrasound technology and knowledge of knee sono-anatomy, an increasing number of studies are investigating the clinical value of ultrasound in the diagnosis and management of ACL injuries. In this regard, the present review aims to elaborate on the sono-anatomy of the ACL, to summarize the evidence for ultrasound imaging for ACL lesions and to investigate whether it is useful in the pre-operative preparation and post-operative follow-up of ACL reconstruction.

The role of ultrasonography in the diagnosis of anterior cruciate ligament injury: A systematic review and meta-analysis

To evaluate the value of ultrasonography in the diagnosis of anterior cruciate ligament injury (ACL injury) by conducting a systematic review and meta-analysis. A literature search was carried out in the Cochrane Library, Embase, Pubmed databases and included studies prior to April 2017. Based on inclusion and exclusion criteria, studies evaluating ultrasound to diagnose ACL injury were selected. MRI, arthroscopy and clinical-follow were considered the reference standards. The diagnostic accuracy of ultrasound was assessed using a combination of sensitivity, specificity, likelihood ratio (LR), post-test probability, diagnostic odds ratio (DOR) and by summarizing the area under the receiver operating characteristic (SROC) curve. A total of 4 studies involving 246 patients were eventually included in the analysis. In these four studies, the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, post-test probability and DOR were 90.0% (95% CI: 77-96), 97% (95% CI: 90-99), 31.08 (95% CI: 8.75-110.41), 0.11 (95% CI: 0.05-0.24), 89% (3%) and 288.81 (95% CI: 78.51-1062.48), respectively. The area under the SROC curve was 0.98 (95% CI: 0.97-0.99). Our meta-analysis showed that ultrasound can play an important role in the diagnosis of ACL injury. Because of its high sensitivity, high specificity and high diagnostic ability, ultrasound should be a part of the standard diagnostic work-up of an ACL injury.