Ultrasound use linked to early diagnosis and efficient quality of care of Ankle Sprain

Mashhad, Iran: S.H.S. Hosseinian et al. have found in a cross sectional study that Ultrasonography is an effective complementary tool for primary evaluation of ankle injuries, which leads to early diagnosis and efficient quality of care.

Ankle injuries may occur during sports activities or every day exercise. Physical examination is mostly the first diagnostic step in the assessment of ankle injuries. Imaging modalities such as ultrasonography (US) and magnetic resonance imaging (MRI) play a major role in providing a detailed depiction of ankle tendons and ligaments. MRI is a reliable diagnostic modality to detect soft tissue pathologies, including joint, ligament, and muscle injuries; however, MRI is not available in many clinical settings and expensive. Ultrasound has the potential to visualize continuity and thickness of muscles and ligaments.

The authors conducted a study to evaluate the sensitivity and specificity of clinical tests and ultrasonography in detecting ankle ligament injuries.

In this cross-sectional study, 105 patients with a history of ankle sprain were included. Ankle ligaments, including syndesmosis of ankle, as well as deltoid, calcaneofibular, anterior talofibular, and posterior talofibular ligaments were evaluated by clinical tests (anterior drawer test (ADT), inversion stress test (IST), eversion stress test (EST), squeeze test (ST), and external rotation stress test (ERST) ultrasonography, and magnetic resonance imaging.

The sensitivity and specificity of ultrasound and clinical tests were assessed in normal, sprain, partial tear, and complete tear groups.

The inter-observer reliability (Cohen's Kappa score) of the evaluated techniques with magnetic resonance imaging was assessed.

Anterior drawer test showed a sensitivity and specificity of 81 and 80% in the detection of anterior talofibular(ATFL) ligament injuries, respectively.

Ultrasonography showed 100% sensitivity and specificity in distinguishing normal anterior talofibular ligament from the torn or sprained ligament with a kappa value of 1.

The sensitivity of ultrasonography in detecting normal calcaneofibular(CFL) ligament and deltoid ligament was 93% and 90%, respectively.

Ultrasonography was highly specific in detecting calcaneofibular ligament tear but it was not sensitive in this regard.

Ultrasonography was proved reliable in determining the normal anterior talofibular ligament and calcaneofibular ligament from the torn or sprained ligament.

In conclusion, compared to MRI, ultrasound yielded 100% and 93% sensitivity in detecting ATFL and CFL injuries, respectively. Ultrasound can be a useful complementary tool for primary evaluation of patients with ankle injuries, which leads to early diagnosis and efficient quality of care. Clinical tests are not reliable to rule out the ankle ligaments injury and the results should be interpreted with alternative assessment tools to increase the diagnostic accuracy.

Further reading:

Diagnostic Value of Ultrasound in Ankle Sprain

Sayyed Hadi Sayyed Hosseinian, Behzad Aminzadeh, Amin Rezaeian, Lida Jarahi, Amirhossein Kasaeian Naeini, Puria Jangjui

The Journal of Foot & Ankle Surgery 61 (2022) 305−309

https://doi.org/10.1053/j.jfas.2021.08.008