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Shi J, Chang Q, Ma M, Wang P, Li J. Diagnostic value of measuring the talofibular space using stress sonography in chronic lateral ankle instability. Eur J Radiol 2024; 170:111273. [PMID: 38113672 DOI: 10.1016/j.ejrad.2023.111273] [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: 05/18/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To investigate the diagnostic value of measuring the talofibular space using stress sonography for chronic lateral ankle instability (CLAI). MATERIALS & METHODS We recruited patients who were clinically diagnosed with CLAI between October 2018 and December 2019 (CLAI group). A control group of healthy volunteers was also included for this study. Both groups underwent a preliminary stress sonographic examination. First, the ultrasonic characteristics of the anterior talofibular ligament (ATFL), including length, thickness, relaxation, calcification, and rupture, were observed using conventional sonography. Second, the talofibular space at the passive neutral position (D1) and maximum varus position (D2) was measured (by stress sonographic images), and the difference (ΔD = D1-D2) between them was determined. Third, the parameters of the two groups were statistically compared. Finally, receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were performed for parameters with significant differences. RESULTS The CLAI group comprised 60 patients, yielding data on 60 ankles, whereas the control group comprised 35 participants, yielding data for 70 ankles. Differences in D1, D2, and ΔD of the talofibular space between the two groups were significant, with ΔD proving to be the best diagnostic indicator (P < 0.001). Its AUC, optimal cutoff value, sensitivity, and specificity were 0.922, 0.11 cm, 73 %, and 94 %, respectively, followed by D2 (0.850, 0.47 cm, 67 %, and 94 %, respectively; P < 0.001) and D1 (0.635, 0.47 cm, 67 %, and 94 %, respectively; P = 0.006). CONCLUSION Measurement of talofibular space in stress sonography is a valuable diagnostic indicator for CLAI, especially the ΔD between the neutral and stress position.
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Affiliation(s)
- Jinjun Shi
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Qin Chang
- Department of Orthopedics, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Ming Ma
- Department of Rehabilitation, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Pingping Wang
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Jia Li
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
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Iwata S, Yamaguchi S, Kimura S, Hattori S, Sasahara J, Akagi R, Amaha K, Atsuta T, Kanzaki N, Noguchi K, Okada H, Omodani T, Ohuchi H, Sato H, Takada S, Takahashi K, Yamada Y, Yasui T, Yokoe T, Fukushima S, Iida D, Ono Y, Kawasaki Y, Shiko Y, Sasho T, Ohtori S. Do standardization of the procedure reduce measurement variability of the sonographic anterior drawer test of the ankle? J Orthop Sci 2023:S0949-2658(23)00320-2. [PMID: 37996296 DOI: 10.1016/j.jos.2023.11.006] [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: 07/31/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND In quantitative ankle stress sonography, different examiners use different techniques, which may cause measurement variability. This study aimed to clarify whether standardizing stress sonography techniques reduces variability in the quantitative measurement of anterior talofibular ligament length change. METHODS Fourteen examiners with a mean ultrasound experience of 8.7 years participated in this study. Each examiner performed stress ultrasonography of the ankle using their preferred method on one patient with an intact anterior talofibular ligament (Patient 1) and on two patients with chronic ankle instability (Patient 2 and 3). Changes in the ligament length between the resting and stressed positions were determined. A consensus meeting was then conducted to standardize the sonographic technique, which was used by the examiners during a repeat stress sonography on the same patients. The variance and measured values were compared between the preferred and standardized techniques using F-tests and paired t-tests, respectively. RESULTS At a consensus meeting, a sonographic technique in which the examiner pushed the lower leg posteriorly against the fixed foot was adopted as the standardized technique. In Patient 1, the change in the anterior talofibular ligament length was 0.4 (range, -2.3-1.3) mm and 0.6 (-0.6-1.7) mm using the preferred and standardized techniques, respectively, with no significant difference in the variance (P = 0.51) or the measured value (P = 0.52). The length changes in Patient 2 were 2.0 (0.3-4.4) mm and 1.7 (-0.9-3.8) mm using the preferred and standardized techniques, respectively. In Patient 3, the length changes were 1.4 (-2.7-7.1) mm and 0.7 (-2.0-2.3) mm. There were no significant differences between the techniques in either patient group. CONCLUSION Variability in the quantitative measurement of ankle stress sonography was not reduced despite the standardization of the technique among examiners. Hence, comparing the measured values between different examiners should be avoided.
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Affiliation(s)
- Shuhei Iwata
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan.
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Soichi Hattori
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Jun Sasahara
- Institute of Sports Science & Medicine, Teikyo University, Tokyo, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Kentaro Amaha
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | | | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Koji Noguchi
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Kurume General Hospital, Fukuoka, Japan
| | | | | | - Hiroshi Ohuchi
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Hiroyuki Sato
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Satoshi Takada
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Kenji Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Chiba, Japan
| | - Yuichi Yamada
- Institute for Integrated Sports Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shun Fukushima
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Daisuke Iida
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Yoshimasa Ono
- Department of Orthopaedic Surgery, Numazu City Hospital, Shizuoka, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
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Peng L, Yu L, Jia J, Gan Y, Ding A, Xiong P, Zhao Y, Yao Y. The effect of thickness and elastic modulus of the anterior talofibular ligament on anterior ankle joint stiffness: A subject-specific finite element study. Front Bioeng Biotechnol 2023; 11:1175347. [PMID: 37180042 PMCID: PMC10166853 DOI: 10.3389/fbioe.2023.1175347] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
Ankle sprain is a frequent type of sports injury leading to lateral ligament injury. The anterior talofibular ligament (ATFL) is a primary ligamentous stabilizer of the ankle joint and typically the most vulnerable ligament injured in a lateral ankle sprain (LAS). This study aimed to quantitively investigate the effect of the thickness and elastic modulus of ATFL on anterior ankle joint stiffness (AAJS) by developing nine subject-specific finite element (FE) models under acute injury, chronic injury, and control conditions of ATFL. A 120 N forward force was applied at the posterior calcaneus leading to an anterior translation of the calcaneus and talus to simulate the anterior drawer test (ADT). In the results, the ratio of the forward force to the talar displacement was used to assess the AAJS, which increased by 5.85% in the acute group and decreased by 19.78% in the chronic group, compared to those of the control group. An empirical equation described the relationship between AAJS, thickness, and elastic modulus (R-square 0.98). The equation proposed in this study provided an approach to quantify AAJS and revealed the effect of the thickness and the elastic modulus of ATFL on ankle stability, which may shed light on the potential diagnosis of lateral ligament injury.
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Affiliation(s)
- Linjing Peng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Yu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Jingyi Jia
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Yaokai Gan
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Angang Ding
- Department of Ultrasound, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Xiong
- Department of Ultrasound, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yichen Zhao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yifei Yao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
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Reliability and validity of ultrasonographic automated length measurement system for assessing talofibular anterior instability in acute lateral ankle sprain. Sci Rep 2023; 13:3098. [PMID: 36813849 PMCID: PMC9947169 DOI: 10.1038/s41598-023-30079-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Ankle joint instability after acute lateral ankle sprain (LAS) is an important factor for deciding treatment strategies. Nevertheless, the degree of ankle joint mechanical instability as a criterion for making clinical decisions is unclear. This study examined the reliability and validity of an Automated Length Measurement System (ALMS) in ultrasonography for assessing real-time anterior talofibular distance. Using a phantom model, we tested whether ALMS could detect two points within a landmark following movement of the ultrasonographic probe. Furthermore, we examined whether ALMS was comparable with the manual measurement method for 21 patients with an acute LAS (42 ankles) during the reverse anterior drawer test. Using the phantom model, ALMS measurements showed excellent reliability, with errors below 0.4 mm and with a small variance. The ALMS measurement was comparable to manually measured values (ICC = 0.53-0.71, p < 0.001) and detected differences in talofibular joint distances between unaffected and affected ankles of 1.41 mm (p < 0.001). ALMS shortened the measurement time by one-thirteenth for one sample compared to the manual measurement (p < 0.001). ALMS could be used to standardize and simplify ultrasonographic measurement methods for dynamic joint movements without human error in clinical applications.
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