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Hattori S, Saggar R, Mullen J, Olawin A, Heidinger E, Austin W, Williams A, Reeves G, Hogan MV. Role of Ultrasound in Evaluating Ligament Injuries Around the Ankle: A Narrative Review. Diagnostics (Basel) 2025; 15:392. [PMID: 39941321 PMCID: PMC11817055 DOI: 10.3390/diagnostics15030392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 01/22/2025] [Accepted: 01/23/2025] [Indexed: 02/16/2025] Open
Abstract
Ultrasound has emerged as a valuable imaging modality for evaluating ligamentous injuries around the ankle joint, offering several advantages over traditional imaging techniques. It is more cost-effective and widely available than MRI, and it avoids the ionizing radiation exposure associated with X-rays, making it a safer option, particularly for pediatric and adolescent populations. In cases of inversion ankle sprains, ultrasound allows for more accurate assessment of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) compared to X-rays and manual examination and yields diagnostic results comparable to MRI. For high ankle sprains involving syndesmosis injuries, ultrasound-especially stress ultrasound-has shown high diagnostic accuracy. Additionally, ultrasound evaluation of the deltoid ligament (DL) in cases of ankle fractures can aid surgeons in determining the need for ligament repair in conjunction with fracture management. This review explores recent developments in ultrasound imaging of the lateral, medial, and syndesmotic ligaments of the ankle joint and discusses its potential applications for evaluating the spring and posterior ligaments. The review provides a comprehensive overview of the ever-expanding role of ultrasound in the management of ankle ligamentous injuries.
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Affiliation(s)
- Soichi Hattori
- Foot and Ankle Injury Research (FAIR), Division of Foot and Ankle, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA; (R.S.); (J.M.); (A.O.); (E.H.); (W.A.); (A.W.); (G.R.); (M.V.H.)
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Kocsis K, Stubnya B, Váncsa S, Kói T, Kovács N, Hergár L, Hetthéssy J, Holnapy G, Hegyi P, Pap K. Diagnostic accuracy of ultrasonography in acute lateral ankle ligament injury: A systematic review and meta-analysis. Injury 2024; 55 Suppl 3:111730. [PMID: 39300628 DOI: 10.1016/j.injury.2024.111730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 06/10/2024] [Accepted: 07/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND The gold standard diagnostic method for acute lateral ankle ligament sprain is magnetic resonance imaging (MRI). However, it is hardly accessible and is time-consuming. Therefore, additional diagnostic methods are warranted. Point-of-care ultrasound, on the other hand, is inexpensive, widely available, time-efficient testing method. PURPOSE Therefore, the aim of this meta-analysis is to determine the diagnostic accuracy of ultrasound for acute ankle ligament injuries compared to MRI. METHODS In our systematic review and meta-analysis, we followed the recommendations of the Cochrane Handbook. We searched the following databases from inception to March 31, 2022: Medline (PubMed), EMBASE, and Cochrane Library. Eligible studies investigated the diagnostic accuracy of US compared to MRI for diagnosing acute lateral ankle ligament injuries. Finally, we calculated pooled sensitivity and specificity with a 95 % confidence interval (CI). RESULTS Eight studies met our eligibility criteria, involving 434 patients. For anterior tibiofibular ligament (ATFL) injury, the summary sensitivity and specificity were Se = 0.97 (CI: 0.89-0.99) and Sp = 0.93 (CI: 0.84-0.97). For calcaneofibular ligament (CFL) injury, the summary sensitivity and specificity were Se.: Se = 0.81 (CI: 0.58-0.93) and Sp = 0.92 [0,81;0,97]. In addition, subgroup analysis based on US performed by different types of investigators was comparable between each other (radiologist group Se = 0.98, CI: 0.24-1, and Sp = 0.91, CI: 0.74-0.97, and the orthopedic/ emergency department group Se = 0.96, CI: 0-1, and Sp = 0.97, CI: 0-1). CONCLUSION Ultrasound showed high diagnostic accuracy for acute lateral ankle ligament injury, irrespective of the investigator. Therefore, based on the current available data, it could be used in primary diagnostics of acute lateral ankle ligament injury.
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Affiliation(s)
- Koppány Kocsis
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Bence Stubnya
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute for Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Norbert Kovács
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Luca Hergár
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Judit Hetthéssy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gergely Holnapy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute for Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Károly Pap
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Traumatology, Semmelweis University, Budapest, Hungary.
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Kakegawa A, Sumitomo N, Nagira A, Ichinose Y, Fukushima N. The calcaneofibular ligament groove at the inferior fibula, an ultrasonographic anatomical landmark. Surg Radiol Anat 2024; 46:739-747. [PMID: 38573504 DOI: 10.1007/s00276-024-03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Calcaneofibular ligament (CFL) injuries are harder to diagnose than anterior talofibular ligament (ATFL) ones. This study aimed to clarify the fibular attachment of the CFL and verify the bony landmark for evaluating the CFL on ultrasonography. METHODS Fifty-nine ankles were used in this anatomical study. To confirm the control function of the CFL, we performed passive movement manually using cadaveric ankles and observed the ankle positions where the CFLs were tense. Histological observation of CFL attachment of the fibula was performed using Masson's trichrome stain. The ATFL and CFL were removed, and the bone morphology of the CFL attachment and inferior fibular end was imaged using a stereomicroscope and a 3D scanner. Using ultrasonography, we evaluated the bone morphology of the fibular attachment of the CFL in short-axis images of 27 healthy adult ankles. RESULTS The CFL was tensed according to ankle motions: supination, maximum dorsi flexion, maximum plantar flexion, and mild plantar flexion-external rotation. Below the CFL attachment of the fibula was a slight groove between the inferior tip and the obscure tubercle of the fibula. This groove was observed in 81.5% of cases using short-axis ultrasonography. CONCLUSION The CFL was tensed in various ankle positions to control the movements of the talocrural and subtalar joints. There was a slight groove at the inferior end of the fibula where the CFL coursed downward. We called it the CFL groove and proposed that it could serve as a landmark for the short-axis image of ultrasonography.
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Affiliation(s)
- Akira Kakegawa
- Faculty of Human Care, Teikyo Heisei University, 2-51-4 Higashi-Ikebukuro, Toshimaku, Tokyo, Japan.
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan.
| | - Norimi Sumitomo
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Ayata Nagira
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Yuko Ichinose
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Nanae Fukushima
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
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Baltes TPA, Geertsema C, Geertsema L, Holtzhausen L, Arnáiz J, Al-Naimi MR, Al-Sayrafi O, Whiteley R, Slim M, D'Hooghe P, Kerkhoffs GMMJ, Tol JL. Acute clinical evaluation for the diagnosis of lateral ankle ligament injuries is useful: A comparison between the acute and delayed settings. Knee Surg Sports Traumatol Arthrosc 2024; 32:550-561. [PMID: 38385771 DOI: 10.1002/ksa.12079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To determine the diagnostic value of seven injury history variables, nine clinical tests (including the combination thereof) and overall clinical suspicion for complete discontinuity of the lateral ankle ligaments in the acute (0-2 days post-injury) and delayed setting (5-8 days post-injury). METHODS All acute ankle injuries in adult athletes (≥18 years) presenting up to 2 days post-injury were assessed for eligibility. Athletes were excluded if imaging studies demonstrated a frank fracture or 3 T MRI could not be acquired within 10 days post-injury. Using standardized history variables and clinical tests, acute clinical evaluation was performed within 2 days post-injury. Delayed clinical evaluation was performed 5-8 days post-injury. Overall, clinical suspicion was recorded after clinical evaluation. MRI was used as the reference standard. RESULTS Between February 2018 and February 2020, a total of 117 acute ankle injuries were screened for eligibility, of which 43 were included in this study. Complete discontinuity of lateral ankle ligaments was observed in 23 (53%) acute ankle injuries. In the acute setting, lateral swelling had 100% (95% confidence interval [CI]: 82-100) sensitivity, haematoma had 85% (95% CI: 61-96) specificity and the anterior drawer test had 100% (95% CI: 77-100) specificity. In the delayed setting, sensitivity for the presence of haematoma improved from 43% (95% CI: 24-65) to 91% (95% CI: 70-98; p < 0.01) and the sensitivity of the anterior drawer test improved from 21% (95% CI: 7-46) to 61% (95% CI: 39-80; p = 0.02). Clinical suspicion had a positive likelihood ratio (LR) of 4.35 (95% CI: 0.55-34.17) in the acute setting and a positive LR of 6.09 (95% CI: 1.57-23.60) in the delayed setting. CONCLUSIONS In the acute setting, clinical evaluation can exclude complete discontinuity (e.g., absent lateral swelling) and identify athletes with a high probability of complete discontinuity (e.g., positive anterior drawer test) of the lateral ankle ligaments. In the delayed setting, the sensitivity of common clinical findings increases resulting in an improved diagnostic accuracy. In clinical practice, this study underlines the importance of meticulous clinical evaluation in the acute setting. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thomas P A Baltes
- Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Celeste Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Liesel Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Louis Holtzhausen
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Exercise and Sports Science, University of the Free State, Bloemfontein, South Africa
| | - Javier Arnáiz
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Maryam R Al-Naimi
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Omar Al-Sayrafi
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rod Whiteley
- Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Monia Slim
- National Sports Medicine Programme, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Johannes L Tol
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Heitz PH, Miron MC, Beauséjour M, Hupin M, DiLiddo L, Jourdain N, Nault ML. Ultrasound Assessment of Ankle Syndesmotic Injuries in a Pediatric Population. Clin J Sport Med 2024; 34:83-90. [PMID: 37882722 DOI: 10.1097/jsm.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To determine sensitivity and specificity for anterior-inferior tibiofibular ligament (AiTFL) integrity and tibiofibular clear-space (TFCS) cut-off points for dynamic evaluation using ultrasound (US) in a pediatric population. DESIGN Prospective cohort study. SETTING Tertiary care university-affiliated pediatric hospital patients between the ages of 12 and 18 sustaining acute ankle trauma with syndesmotic injury. INTERVENTIONS Participants were assigned to the syndesmotic injury protocol that included a standardized MRI and US. MAIN OUTCOME MEASURES Anterior-inferior tibiofibular ligament integrity for static assessment and TFCS measurements for dynamic assessment on US. For dynamic assessment, the distance between the distal tibia and fibula was first measured in neutral position and then in external rotation for each ankle. The US results on AiTFL integrity were compared with MRI, considered as our gold standard. Optimal cut-off points of TFCS values were determined with receiver operating characteristics curve analysis. RESULTS Twenty-six participants were included. Mean age was 14.8 years (SD = 1.3 years). Sensitivity and specificity for AiTFL integrity were 79% and 100%, respectively (4 false negatives on partial tears). For dynamic assessment, the cut-off points for the differences in tibiofibular distance between the 2 ankles in 1) neutral position (TFCS N I-U ) and 2) external rotation (TFCS ER I-U ) were 0.2 mm (sensitivity = 83% and specificity = 80%) and 0.1 mm (sensitivity = 83% and specificity = 80%), respectively. CONCLUSIONS Static US could be used in a triage context as a diagnostic tool for AiTFL integrity in a pediatric population as it shows good sensitivity and excellent specificity.
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Affiliation(s)
- Pierre-Henri Heitz
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Marie-Claude Miron
- Department of Radiology, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Radiology, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Marie Beauséjour
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Sherbrooke, Université de Sherbrooke-Campus Longueuil, Longueuil, QC, Canada
| | - Mathilde Hupin
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Lydia DiLiddo
- Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | | | - Marie-Lyne Nault
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
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Pirri C, Stecco C, Güvener O, Mezian K, Ricci V, Jačisko J, Fojtik P, Kara M, Chang KV, Dughbaj M, Özçakar L. EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Ankle/Foot. Am J Phys Med Rehabil 2024; 103:e29-e34. [PMID: 37903600 DOI: 10.1097/phm.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
ABSTRACT In this dynamic scanning protocol, ultrasound examination of the ankle is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine.
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Affiliation(s)
- Carmelo Pirri
- From the Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CP, CS); Department of Physical and Rehabilitation Medicine, Mersin University Medical School, Mersin, Turkey (OG); Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine, Prague, Czech Republic (KM); Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic (JJ); Institute of Anatomy, Charles University, First Faculty of Medicine, Prague, Czech Republic, Department of Orthopedics, The Central Military Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic (PF); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, L Ö); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taiwan (K.-VC); National Taiwan University College of Medicine, Taipei, Taiwan (K.-VC); Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait (MD)
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Rougereau G, Marty-Diloy T, Vigan M, Donadieu K, Vialle R, Langlais T, Hardy A. Biomechanical evaluation of the anterior talo-fibular and calcaneo-fibular ligaments using shear wave elastography in young healthy adults. Orthop Traumatol Surg Res 2024; 110:103647. [PMID: 37356798 DOI: 10.1016/j.otsr.2023.103647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the stiffness of the anterior talo-fibular ligament (ATFL) and calcaneo-fibular ligament (CFL) using shear wave elastography (SWE) with the ankle in the neutral position and in varus, in young healthy adult volunteers. We also evaluated the reliability and reproducibility of the SWE measurements. HYPOTHESIS The stiffness of both ligaments increases with increasing ankle varus. SWE may be a reliable tool for evaluating the lateral collateral ligament complex of the ankle. MATERIAL AND METHODS We used SWE to evaluate both ankles of each of 20 healthy volunteers (10 females and 10 males). For each test, the foot was placed on a hinged plate and tested in the neutral position and in 15° and 30° of varus. Stiffness was evaluated based on shear wave velocity (SWV). RESULTS Stiffness of both the ATFL and CFL was minimal in the neutral position (2.06m/s and 3.43m/s, respectively). Stiffness increased significantly for both ligaments in 15° of varus (2.48m/s and 4.11m/s, respectively; p<0.0001) and was greatest in 30° of varus (3.15m/s and 4.57m/s, respectively; p<0.0001). ATFL stiffness was greater in males than in females in 15° (p=0.04) and 30° (p=0.02) of varus. For the CFL, in contrast, stiffness was not different between males and females. Stiffness of the ATFL and CFL was not associated with age, dominant side, height, or foot morphology. No correlations were found between stiffness of the two ligaments in any of the positions. Repeating each measurement three times produced excellent concordance for both ligaments in all three positions. CONCLUSION The ATFL and CFL are the main lateral stabilisers of the ankle, and each exerts a specific function. Their stiffness increases with the degree of varus. This study describes a protocol for evaluating ATFL and CFL density by SWE, which is a reliable and reproducible technique that provides a normal range. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Grégoire Rougereau
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique adulte, hôpital de la Pitié-Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France.
| | - Thibault Marty-Diloy
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Marie Vigan
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Unité de recherche clinique, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - Kalinka Donadieu
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphaël Vialle
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département hospitalo-universitaire MAMUTH pour les thérapies innovantes dans les maladies musculosquelettiques, université de la Sorbonne, Paris, France
| | - Tristan Langlais
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique pédiatrique, hôpital des enfants, université de Toulouse, Purpan, Toulouse, France
| | - Alexandre Hardy
- Département de chirurgie orthopédique, clinique du sport, 75005 Paris, France
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Jones JC, Schultz C, Podvin C, Mikhail D, Radel LC. Point-of-Care Ultrasound (POCUS) for Sideline Youth Sports Coverage. Curr Rev Musculoskelet Med 2023; 16:493-500. [PMID: 37566361 PMCID: PMC10587036 DOI: 10.1007/s12178-023-09859-7] [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] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the use of point-of-care ultrasound for sideline youth sports coverage. RECENT FINDINGS Participation in youth sports has been increasing, with trends that athletes are specializing earlier and competing at higher levels at younger ages (NSCH 2019, Fabricant 2013). Point-of-care ultrasound (POCUS) utilizes non-invasive imaging to diagnose and manage various musculoskeletal conditions ranging from traumatic injuries, such as fractures and intramuscular hematomas, to early screening for conditions such as asymptomatic knee lesions. Since it is well-tolerated by children and adolescents and allows for easy accessibility for sideline care, POCUS could provide a strong alternative to other imaging modalities such as x-ray and magnetic resonance imaging (MRI) as both have their limitations. Youth sideline sports coverage could be enhanced with immediate medical attention from ultrasound-trained medical professionals. On the sidelines of a traumatic injury, POCUS expedites patient care with immediate examination of acute injuries. In low resource and hard-to-reach locations such as a rural youth sporting event, it can be key in the triaging of injuries. As a supplement to a physical exam, the risk of a misdiagnosis is reduced, and a long, expensive trip to the hospital for unnecessary imaging studies may be avoided. Ultrasound is a versatile, non-invasive, radiation-free imaging modality that serves as an accessible option for sideline coverage at youth sporting events. Ultrasound is well-tolerated by children and adolescents. It can be used to evaluate, diagnose, and manage a range of musculoskeletal conditions at the sidelines of youth sports.
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Affiliation(s)
- Jacob C. Jones
- Scottish Rite for Children, 5700 Dallas Pkwy Frisco, Dallas, TX 75034 USA
- University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Cassidy Schultz
- Scottish Rite for Children, 5700 Dallas Pkwy Frisco, Dallas, TX 75034 USA
| | - Caroline Podvin
- Scottish Rite for Children, 5700 Dallas Pkwy Frisco, Dallas, TX 75034 USA
| | - David Mikhail
- University of Texas Southwestern Medical Center, Dallas, TX USA
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Wenning M, Schmal H. Chronic Ankle Instability - Mechanical vs. Functional. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:552-562. [PMID: 35158394 DOI: 10.1055/a-1696-2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic ankle instability arises from three interacting contributing factors: mechanical ankle instability, functional ankle instability, and perceived ankle instability. To decide on the most appropriate individual recommendation for therapeutic options, it is necessary to assess which of the two main aetiologies - functional vs. mechanical - is dominant in causing the perceived impairment. It is essential to perform a thorough analysis and diagnosis, even though quantifying mechanical ankle instability is still a challenge in the clinical approach to this common pathology. When diagnosing mechanical instability, the most established procedure is physical examination, although this unfortunately does not allow the deficit to be quantified. Additional options include stress-ultrasound, 3D stress-MRI (3SAM), ankle arthrometry, marker-based 3D motion analysis, and diagnostic ankle arthroscopy. Of these the latter is considered the gold standard, even though it is an invasive procedure, it may not be performed for diagnostic reasons only, and it also does not allow the mechanical instability to be quantified. For diagnosing functional instability there are non-instrumented tests such as the Star Excursion Balance Test or Y-Balance Test, posturography/stabilometry, and gait and running analysis, possibly combined with EMG acquisition and isokinetic strength testing.To date, the standard of care is conservative management of ankle instability, and the therapy should include sensorimotor training, strength training of the periarticular muscles, balance training, and gait and running exercises on different surfaces. However, it is increasingly clear that a certain degree of mechanical instability cannot be compensated for by functional training. Thus, it is the goal of differential diagnostics to identify those patients and guide them to mechanical therapy, including ankle bracing, taping, and surgical ligament reconstruction.
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Affiliation(s)
- Markus Wenning
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universität Freiburg Medizinische Fakultät, Freiburg, Deutschland
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, Albert-Ludwigs-Universitat Freiburg Medizinische Fakultat, Freiburg, Deutschland
- Department of Orthopedic Surgery, Odense University Hospital Department of Orthopaedic Surgery, Odense, Denmark
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10
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Fujishiro H, Nimura A, Azumaya M, Hattori S, Hoshi O, Akita K. Anatomical study of the bone morphology of the anterior talofibular ligament attachment. Anat Cell Biol 2023; 56:334-341. [PMID: 37482888 PMCID: PMC10520850 DOI: 10.5115/acb.23.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/23/2023] [Accepted: 05/19/2023] [Indexed: 07/25/2023] Open
Abstract
Anterior talofibular ligament (ATFL) injuries are the most common cause of ankle sprains. To ensure anatomically accurate surgery and ultrasound imaging of the ATFL, anatomical knowledge of the bony landmarks around the ATFL attachment to the distal fibula is required. The purpose of the present study was to anatomically investigate the ATFL attachment to the fibula with respect to bone morphology and attachment structures. First, we analyzed 36 feet using microcomputed tomography. After excluding 9 feet for deformities, the remaining 27 feet were used for chemically debrided bone analysis and macroscopic and histological observations. Ten feet of living specimens were observed using ultrasonography. We found that a bony ridge was present at the boundary between the attachments of the ATFL and calcaneofibular ligament (CFL) to the fibula. These two attachments could be distinguished based on a difference in fiber orientation. Histologically, the ATFL was attached to the anterodistal part of the fibula via fibrocartilage anterior to the bony ridge indicating the border with the CFL attachment. Using ultrasonography in living specimens, the bony ridge and hyperechoic fibrillar pattern of the ATFL could be visualized. We established that the bony ridge corresponded to the posterior margin of the ATFL attachment itself. The ridge was obvious, and the superior fibers of the ATFL have directly attached anteriorly to it. This bony ridge could become a valuable and easy-to-use landmark for ultrasound imaging of the ATFL attachment if combined with the identification of the fibrillar pattern of the ATFL.
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Affiliation(s)
- Hitomi Fujishiro
- Department of Anatomy and Physiological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mizuki Azumaya
- Department of Anatomy and Physiological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichi Hattori
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Osamu Hoshi
- Department of Anatomy and Physiological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Meyer R, Loncar LR, Jensen E, Raja A, Tunis B, Moreland ML, Tunis J. The Role of Ultrasound in the Management of Ankle Sprains and a Clinically Relevant Geisinger Ankle Sprain Sports Ultrasound Protocol. Curr Sports Med Rep 2023; 22:320-327. [PMID: 37678351 DOI: 10.1249/jsr.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
ABSTRACT Ankle sprains are the most common lower extremity injury in physically active individuals. These injuries are classified as lateral, medial, and/or syndesmotic. Treatment may include functional rehabilitation, bracing, weight-bearing restriction, medications, injections, and surgery. While most sprains heal rapidly, permanent disability and pain may arise. Diagnostic ultrasound has been demonstrated to be accurate in diagnosing ligamentous injuries, but it is often excluded from management algorithms that rely on physical examination alone to diagnose significant injuries. This article proposes a comprehensive, evidence-based diagnostic ankle ultrasound protocol to implement in conjunction with thorough history and physical examination. We also review the current literature to describe where this protocol most improves diagnostic accuracy compared with physical examination alone.
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Affiliation(s)
| | | | | | - Altamash Raja
- Department of Rehabilitation Medicine, Rowan-Virtua School of Osteopathic Medicine, Sewell, NJ
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12
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Deutekom FE, Ridderikhof ML, Van Etten-Jamaludin F, Schepers T. Accuracy of ultrasound in diagnosing ankle injuries in emergency care. Emerg Med J 2023; 40:569-575. [PMID: 37173124 DOI: 10.1136/emermed-2022-212516] [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: 04/26/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Ankle injuries are one of the most common presentations in the ED. Although fractures can be ruled out using the Ottawa Ankle Rules, the specificity is low, which means many patients may still receive unnecessary radiographs. Even once fractures are ruled out, assessment of ankle stability is recommended to rule out ruptures, but the anterior drawer test has only moderate sensitivity and low specificity and should be performed only after swelling has receded. Ultrasound could be a reliable, cheap and radiation free alternative to diagnose fractures and ligamentous injuries. The purpose of this systematic review was to investigate the accuracy of ultrasound in diagnosing ankle injuries. METHODS Medline, Embase and the Cochrane Library were searched up to 15 February 2022 to include studies of patients of 16 years or older presenting to the ED with acute ankle or foot injury, who underwent ultrasound and had diagnostic accuracy as outcome. No restrictions were applied for date and language. Risk of bias and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach were assessed. RESULTS Thirteen studies evaluating 1455 patients with bony injuries were included. In 10 studies, the reported sensitivity for fracture was >90%, but varied among studies between 76% (95% CI 63% to 86%) and 100% (95% CI 29% to 100%). In nine studies, the reported specificity was at least 91%, but varied between 85% (95% CI 74% to 92%) and 100% (95% CI 88% to 100%).Six studies including 337 patients examined the use of ultrasound for ligamentous injuries and found a sensitivity and specificity >94% and 100%. Overall quality of evidence for both bony and ligamentous injuries was low and very low. CONCLUSION Ultrasound has the potential to be a reliable method for diagnosing foot and ankle injuries, however, higher grade evidence is needed. PROSPERO REGISTRATION NUMBER CRD42020215258.
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Affiliation(s)
- Fenna E Deutekom
- Faculty of medicine, University of Amsterdam, Amsterdam, The Netherlands
- Emergency Medicine, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
| | | | | | - Tim Schepers
- Trauma Surgery, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
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13
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Abstract
Injuries of the medial ankle ligament complex (MALC; deltoid and spring ligament) are more common following ankle sprains than expected, especially in eversion-external rotation mechanisms. Often these injuries are associated with concomitant osteochondral lesions, syndesmotic lesions, or fractures of the ankle joint. The clinical assessment of the medial ankle instability together with a conventional radiological and MR imaging is the basis for the definition of the diagnosis and therefore the optimal treatment. This review aims to provide an overview as well as a basis to successfully manage MALC sprains.
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Affiliation(s)
- Patrick Pflüger
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Victor Valderrabano
- SWISS ORTHO CENTER, Swiss Medical Network, Schmerzklinik Basel, University of Basel, Hirschgässlein 15, Basel 4010, Switzerland.
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14
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Chen RP, Wang QH, Li MY, Su XF, Wang DY, Liu XH, Li ZL. Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament. World J Clin Cases 2023; 11:3395-3407. [PMID: 37383912 PMCID: PMC10294195 DOI: 10.12998/wjcc.v11.i15.3395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/07/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Injury to the anterior talofibular ligament (ATFL) is a common acute injury of the lateral foot ligament. Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients. The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL. The clinical manifestations of acute injury to the ATFL include pain, swelling, and dysfunction. At present, non-surgical treatment is the first choice for acute injury of the ATFL. The standard treatment strategy involves the "peace and love" principle. After initial treatment in the acute phase, personalized rehabilitation training programs can be followed. These may involve proprioception training, muscle training, and functional exercise to restore limb coordination and muscle strength. Static stretching and other techniques to loosen joints, acupuncture, moxibustion massage, and other traditional medical treatments can relieve pain, restore range of motion, and prevent joint stiffness. If the non-surgical treatment is not ideal or fails, surgical treatment is feasible. Currently, arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice. Although open Broström surgery provides good results, the modified arthroscopic Broström surgery has many advantages, such as less trauma, rapid pain relief, rapid postoperative recovery, and fewer complications, and is more popular with patients. In general, when treating acute injury to the ATFL, treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.
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Affiliation(s)
- Run-Peng Chen
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Qing-Hua Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Ming-Yue Li
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Xiao-Fang Su
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Dong-Yang Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
- Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Xing-Hui Liu
- Department of Office, Shandong Vheng Data Technology Co., Ltd, Yantai 264003, Shandong Province, China
| | - Zhi-Li Li
- Department of Office, Shandong Vheng Data Technology Co., Ltd, Yantai 264003, Shandong Province, China
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15
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Jungmann PM, Lange T, Wenning M, Baumann FA, Bamberg F, Jung M. Ankle Sprains in Athletes: Current Epidemiological, Clinical and Imaging Trends. Open Access J Sports Med 2023; 14:29-46. [PMID: 37252646 PMCID: PMC10216848 DOI: 10.2147/oajsm.s397634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Ankle injuries are frequent sports injuries. Despite optimizing treatment strategies during recent years, the percentage of chronification following an ankle sprain remains high. The purpose of this review article is, to highlight current epidemiological, clinical and novel advanced cross-sectional imaging trends that may help to evaluate ankle sprain injuries. Methods Systematic PubMed literature research. Identification and review of studies (i) analyzing and describing ankle sprain and (ii) focusing on advanced cross-sectional imaging techniques at the ankle. Results The ankle is one of the most frequently injured body parts in sports. During the COVID-19 pandemic, there was a change in sporting behavior and sports injuries. Ankle sprains account for about 16-40% of the sports-related injuries. Novel cross-sectional imaging techniques, including Compressed Sensing MRI, 3D MRI, ankle MRI with traction or plantarflexion-supination, quantitative MRI, CT-like MRI, CT arthrography, weight-bearing cone beam CT, dual-energy CT, photon-counting CT, and projection-based metal artifact reduction CT may be introduced for detection and evaluation of specific pathologies after ankle injury. While simple ankle sprains are generally treated conservatively, unstable syndesmotic injuries may undergo stabilization using suture-button-fixation. Minced cartilage implantation is a novel cartilage repair technique for osteochondral defects at the ankle. Conclusion Applications and advantages of different cross-sectional imaging techniques at the ankle are highlighted. In a personalized approach, optimal imaging techniques may be chosen that best detect and delineate structural ankle injuries in athletes.
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Affiliation(s)
- Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | - Thomas Lange
- Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Markus Wenning
- Department of Orthopedic and Trauma Surgery, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frédéric A Baumann
- Department of Vascular Medicine, Hospital of Schiers, Schiers, Switzerland
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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16
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Ergün T, Peker A, Aybay MN, Turan K, Muratoğlu OG, Çabuk H. Ultrasonography vıew for acute ankle ınjury: comparison of ultrasonography and magnetic resonance ımaging. Arch Orthop Trauma Surg 2023; 143:1531-1536. [PMID: 35867114 DOI: 10.1007/s00402-022-04553-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We aim to asses the diagnostic performance of ankle ultrasonography in patients presenting with acute ankle sprain injury, with comparison to MRI (Manyetik Rezonans İmaging). MATERIALS AND METHODS The study included patients who applied to the hospital within 48 h after an ankle sprain, and who presented with signs of pain, swelling, and tenderness in the ankle. Ankle ultrasonography examination was performed and an ankle MRI took place the same day. RESULTS 30 patients were included in the study. 53.3% (n = 16) were female. The mean age was 30 ± 6.4 years. The ultrasonography examination determined 76.6% (n = 23) of the patients to have anterior talofibular ligament (ATFL) injury, 33.3% to have (n = 10) CFL injury, and 33.3% to have (n = 10) anterior inferior tibia-fibular ligament (AITFL) injury. The MRI of the patients determined 73.3% (n = 22) of the patients to have ATFL injury, 43.3% (n = 13) to have calcaneal fibular ligament (CFL) injury, and 33.3% to have (n = 10) AITFL injury. The ATFL, CFL, and AITFL injuries diagnosed on ultrasonography correlated with the MRI results (ICC = 0.875, ICC = 0.879, and ICC = 0.858). However, among the ATFL injuries observed on MRI, 26.6% (n = 8) were grade I, 26.6% (n = 8) were grade II, and 20% (n = 6) were grade III injuries. Of the ATFL injuries observed on ultrasonography, 46.6% (n = 14) were grade I, 8.6% (n = 2) were grade II, and 30.4% (n = 7) were grade III injuries. CONCLUSIONS Findings on all types of ATFL, CFL and AITFL appear to have a higher degree of correlation. Ultrasonography could have an added role as a triaging tool, to fast-track MRI.
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Affiliation(s)
- Tuğrul Ergün
- Department of Orthopedics and Traumatology, Istinye University Bahçeşehir Liv Hospital, Istanbul, Turkey.
| | - Ahmet Peker
- Koç University Hospital, İstanbul, Zeytinburnu, Türkiye
| | | | - Kaya Turan
- Department of Orthopedics and Traumatology, Istinye University Bahçeşehir Liv Hospital, Istanbul, Turkey
| | - Osman G Muratoğlu
- Department of Orthopedics and Traumatology, Istinye University Bahçeşehir Liv Hospital, Istanbul, Turkey
| | - Haluk Çabuk
- Department of Orthopedics and Traumatology, Istinye University Bahçeşehir Liv Hospital, Istanbul, Turkey
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17
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Kakegawa A, Fukushima N, Sumitomo N, Nagira A, Ichinose Y. Difference in the fibular attachment structure between the superior and inferior fascicles of the anterior talofibular ligament using ultrasonography and histological examinations. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1513-1520. [PMID: 36449085 DOI: 10.1007/s00276-022-03049-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE The anterior talofibular ligament (ATFL) is divided into superior (SB) and inferior bands (IB). Although the differences in length and width are known, the structure of the fibular attachment had not been elucidated. The present study aimed to clarify the differences in the fibular attachment structure between ATFL's SB and IB using cross-sectional images along the ligament. METHODS An anatomical study using 15 formalin-fixed ankles was performed. The lateral ankle ligament complex was collected after a longitudinal image of SB/IB was visualized by ultrasonography. The specimens were decalcified and sectioned longitudinally at the center of SB/IB using a microtome. Histological evaluation of the enthesis structure at the fibular attachment of SB/IB was performed using hematoxylin-eosin and Masson's trichrome stains. RESULTS A fibrillar pattern could not be observed in the longitudinal image at the IB level by ultrasonography. The lengths of ATFL's SB and IB were 20.6 ± 1.6 and 15.3 ± 1.3 mm, respectively, with thicknesses of 1.8 ± 0.4 and 1.0 ± 0.4 mm, respectively. The ATFL's IB was significantly shorter and thinner than the ATFL's SB. The fibular attachment of ATFL's SB had distinct enthesis structure, whereas in the attachment structure of the ATFL's IB, there were several variations including a type with a narrower enthesis structure than the ATFL's SB and a type that merged with or wrapped around the calcaneofibular ligament. CONCLUSION The fibular attachment structure between ATFL's SB and IB differs. Our results could be useful information when performing ultrasonography and MRI diagnosis.
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Affiliation(s)
- Akira Kakegawa
- Faculty of Human Care, Teikyo Heisei University, 2-51-4 Higashi-Ikebukuro, Toshimaku, Tokyo, Japan. .,Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan.
| | - Nanae Fukushima
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Norimi Sumitomo
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Ayata Nagira
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Yuko Ichinose
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
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18
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Rougereau G, Langlais T, Vigan M, Hardy A, Vialle R, Marty-Diloy T, Cambon-Binder A. Ankle syndesmosis biomechanical evaluation by shear-waves elastography in healthy young adults: Assessment of the reliability and accuracy of the measurements and definition of a corridor of normality. Foot Ankle Surg 2022; 28:1279-1285. [PMID: 35717494 DOI: 10.1016/j.fas.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Aims of this study were: 1/ to evaluate the shear wave speed (SWS) properties of the anteroinferior tibiofibular ligament (AITFL) and the distal interosseous membrane (DIOM) in neutral, dorsal flexion and plantar flexion positions in a cohort of healthy adult volunteers; 2/ to assess the reliability and reproducibility of these measurements. METHODS Both ankles were analyzed by shear wave elastography (SWE) in 20 healthy patients (10 females/10 males) standing on a hinge support with their ankles in neutral, 20° dorsal flexion and 30° plantar flexion positions. Stiffness of AITFL and DIOM was evaluated by SWS measurement. RESULTS The SWS of AITFL and DIOM were minimal in the plantar flexion position (4.28 m/s [2.65-5.11] and 3.35 m/s [1.69-4.55], respectively). It increased significantly for both ligaments in neutral position (4.69 m/s [3.53-5.71] and 3.81 m/s [1.91-4.74], respectively; p < 0.0001), and reached their maximum values in dorsal flexion (6.58 m/s [5.23-8.34] and 4.79 m/s [3.07-6.19], respectively; p < 0.0001). There was no correlation between each ligament regardless the positions. SWS of AITFL was independent of demographic characteristics analyzed. SWS of DIOM was negatively correlated with height in dorsal flexion (ρ = -0.35; p = 0.03) and in plantar flexion (ρ = -0.37; p = 0.02). Female gender was associated with increased DIOM SWS in neutral (p = 0.005), dorsal flexion (p = 0.003), and plantar flexion (p = 0.001) positions. Moreover, foot morphology (foot arch, hind foot frontal deviation) did not impact AITFL nor DIOM SWS. Inter- and intra-observer measurements were all good or excellent. CONCLUSION The AITFL and DIOM, stabilizers of the distal tibiofibular syndesmosis, increase in stiffness while dorsal flexion increases. This study describes a reliable and reproducible protocol to assess their stiffness by SWE, and defines a corridor of normality.
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Affiliation(s)
- Grégoire Rougereau
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Sorbonne University, Department of Adult Orthopedic Surgery, Pitié-Salpêtrière Hospital, APHP, 75571 Paris, France.
| | - Tristan Langlais
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Toulouse University, Department of Pediatric Orthopedic Surgery, Children's Hospital, Purpan, Toulouse, France
| | - Marie Vigan
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Department of Adult Orthopedic surgery, Hospital Ambroise Paré, APHP, 92100 Boulogne-Billancourt, France
| | - Alexandre Hardy
- Clinique du sport, Department of Orthopedic Surgery, 75005 Paris, France
| | - Raphaël Vialle
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
| | - Thibault Marty-Diloy
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France
| | - Adeline Cambon-Binder
- Sorbonne University, Department of Adult Orthopedic Surgery, Saint Antoine Hospital, APHP, 75571 Paris, France
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Baltes TPA, Al Sayrafi O, Arnáiz J, Al-Naimi MR, Geertsema C, Geertsema L, Holtzhausen L, D'Hooghe P, Kerkhoffs GMMJ, Tol JL. Acute clinical evaluation for syndesmosis injury has high diagnostic value. Knee Surg Sports Traumatol Arthrosc 2022; 30:3871-3880. [PMID: 35508553 PMCID: PMC9568458 DOI: 10.1007/s00167-022-06989-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the diagnostic value of injury history, physical examination, six syndesmosis tests and overall clinical suspicion for syndesmosis injury. METHODS All athletes (> 18 yrs) with an acute ankle injury presenting within 7 days post-injury were assessed for eligibility. Acute ankle injuries were excluded if imaging studies demonstrated a frank fracture or 3 T MRI could not be acquired within 10 days post-injury. Standardized injury history was recorded, and physical examination was performed by an Orthopaedic Surgeon or Sports Medicine Physician. Overall clinical suspicion was documented prior to MRI. Multivariate logistic regression was used to determine the association between independent predictors and syndesmosis injury. RESULTS Between September 2016 and July 2019, a total of 150 acute ankle injuries were included. The median time from injury to acute clinical evaluation was 2 days (IQR 2). Prior to clinical evaluation, the median patient reported Visual Analog Scale for pain was 8/10 (IQR 2). Syndesmosis injury was present in 26 acute ankle injuries. An eversion mechanism of injury had a positive LR 3.47 (CI 95% 1.55-7.77). The squeeze tests had a positive LR of 2.20 (CI 95% 1.29-3.77) and a negative LR of 0.68 (CI 95% 0.48-0.98). Overall clinical suspicion had a sensitivity of 73% (CI 95% 52-88) and negative predictive value of 89% (CI 95% 78-95). Multivariate regression analyses demonstrated significant association for eversion mechanism of injury (OR 4.99; CI 95% 1.56-16.01) and a positive squeeze test (OR 3.25; CI 95% 1.24-8.51). CONCLUSIONS In an acute clinical setting with patients reporting high levels of ankle pain, a negative overall clinical suspicion reduces the probability of syndesmosis injury. Eversion mechanism of injury and a positive squeeze test are associated with higher odds of syndesmosis injury. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thomas P A Baltes
- Research Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.
| | - Omar Al Sayrafi
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Javier Arnáiz
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Maryam R Al-Naimi
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Celeste Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Liesel Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Louis Holtzhausen
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Johannes L Tol
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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20
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Kandemir V, Akar MS, Yiğit Ş, Durgut F, Atiç R, Özkul E. Can American Orthopaedic Foot and Ankle Society (AOFAS) score prevent unnecessary MRI in isolated ankle ligament injuries? J Orthop Surg (Hong Kong) 2022; 30:10225536221131374. [PMID: 36192368 DOI: 10.1177/10225536221131374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE Ankle injuries are the most common musculoskeletal injuries. Its incidence is also high among sports injuries. Direct X-ray, ultrasound and MRI can be requested after the history and physical examination in the patient who presents with ankle ligament injury. Some classifications are used for requesting direct X-ray after ankle injury. Since clear limits are not specified in the literature for MRI, the rate of unnecessary MRI examinations is high. We argue that the decision can be made according to the AOFAS score to be checked before MR is requested, and thus unnecessary MR requests can be reduced. MATERIAL AND METHOD Ankle MRI images of patients who underwent ankle MRI due to ankle trauma between January 2018 and December 2020 were scanned. 328 patients who met the criteria were included in the study. Patients with AOFAS scores in their outpatient clinic records were identified. AOFAS scores of patients with at least one ligament injury and those with normal MR images were statistically compared. Sensitivity and specificity were determined for the AOFAS score using ROC analysis. RESULTS Patients with ligament damage as a result of MRI examination were 21.3% (n=70), and patients without any ligament damage were 78.7% (n=258). There was a statistically significant difference in terms of AOFAS between the group with ligament damage and the group without ligament damage (p< 0.05). In the ROC analysis, the AOFAS threshold value for MR request was determined as 80.5 (84.3% sensitivity and 72.3% specificity). Based on the determined threshold value, 73 patients who had unnecessary MRI would have been eliminated, thus reducing the number of MRIs by 42.6%. CONCLUSION The AOFAS scores of patients with ligament damage were statistically significantly lower than those of patients without ligament pathology. Unnecessary MRI can be significantly prevented by using the AOFAS score in ankle traumas without bone fractures.
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Affiliation(s)
- Veysel Kandemir
- Department of Orthopaedic Surgery, Tatvan State Hospital, Bitlis, Turkey
| | - Mehmet Sait Akar
- Department of Orthopaedic Surgery, 37507Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Şeyhmus Yiğit
- Department of Orthopaedic Surgery, 37507Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Fatih Durgut
- Department of Orthopaedic Surgery, 37507Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Ramazan Atiç
- Department of Orthopaedic Surgery, 37507Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Emin Özkul
- Department of Orthopaedic Surgery, 37507Dicle University, Faculty of Medicine, Diyarbakır, Turkey
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21
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Hagemeijer NC, Lubberts B, Saengsin J, Bhimani R, Sato G, Waryasz GR, Kerkhoffs GMMJ, DiGiovanni CW, Guss D. Portable dynamic ultrasonography is a useful tool for the evaluation of suspected syndesmotic instability: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2022; 31:1986-1993. [PMID: 35881148 PMCID: PMC10089982 DOI: 10.1007/s00167-022-07058-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/20/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Portable ultrasonography (P-US) is increasingly used to diagnose syndesmotic instability. The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P-US with progressive stages of syndesmotic ligamentous transection under external rotation stress. METHODS Ten fresh lower leg cadaveric specimens amputated above the proximal tibiofibular joint were used. Using P-US, the TFCS was evaluated in the intact stage and after progressive sectioning of the (1) anterior-inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), and (3) posterior-inferior tibiofibular ligament (PITFL). The TFCS was measured in both the unstressed (0 Nm) state and with 4.5, 6.0, 7.5, and 9.0 Nm of external rotation stress using a bone hook placed on the first metatarsal bone at each stage of ligamentous transection stage using both P-US and fluoroscopy. RESULTS When assessed with P-US, partial syndesmotic injury encompassing the AITFL and IOL resulted in significant TFCS widening at 4.5 Nm of external rotation torque when compared to intact state with a TFCS-opening of 2.6 ± 2 mm, p = 0.01. In contrast, no significant differences in TFCS were detected using fluoroscopy. Only a moderate correlation was found between P-US and fluoroscopy. CONCLUSION P-US is a useful tool in diagnosing syndesmotic instability during external rotation stress examination. TFCS-opening increased as additional ligaments of the syndesmosis were transected, and application of 4.5 Nm torque was sufficient to detect a difference of 2.6 mm after the IOL cut.
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Affiliation(s)
- N C Hagemeijer
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA. .,Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Zuidoost, 1105 AZ, Amsterdam, The Netherlands. .,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands. .,Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - B Lubberts
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
| | - J Saengsin
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Department of Orthopaedic Surgery, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot, Sri Phum subdistrict, Mueang Chiang Mai District, Chiang Mai 50200, Chiang Mai, Thailand.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
| | - R Bhimani
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
| | - G Sato
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
| | - G R Waryasz
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Building, 55 Fruit St, Boston, MA, 02114, USA.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Zuidoost, 1105 AZ, Amsterdam, The Netherlands.,Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, 2014 Washington St, Newton, MA, 02462, USA.,Academic Center for Evidence Based Sports Medicine (ACES), Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
| | - C W DiGiovanni
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Building, 55 Fruit St, Boston, MA, 02114, USA.,Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, 2014 Washington St, Newton, MA, 02462, USA.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
| | - D Guss
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Building, 55 Fruit St, Boston, MA, 02114, USA.,Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, 2014 Washington St, Newton, MA, 02462, USA.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
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22
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Chans-Veres J, Vallejo-Márquez M, Galhoum AE, Tejero S. Analysis of the uninjured tibiofibular syndesmosis using conventional CT-imaging and axial force in different foot positions. Foot Ankle Surg 2022; 28:650-656. [PMID: 34376323 DOI: 10.1016/j.fas.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Syndesmosis measurments and indices have been controversial and showed interindividual variability. The purpose of this study was to analyze, by conventional axial computed tomography images and a simulated load device, the uninjured tibiofibular syndesmosis under axial force and forced foot positions. METHODS A total of 15 healthy patients (30 ankles) were studied using adjustable simulated load device (ASLD). This device allowed to perform bilateral ankle CT scans in two forced foot and ankle positions (30° of plantar flexion, 15° of inversion, 20° of internal rotation and 15° of dorsal flexion, 15° of eversion, 30° of external rotation). Axial load was applied simultaneously in a controlled manner (70% body weight). Measurements on the axial image of computed tomography were: syndesmotic area (SA), fibular rotation (FR), position of the fibula in the sagittal plane (FPS), depth of the incisura (ID) and direct anterior difference (ADD), direct middle difference (MDD) and direct posterior difference (PDD). RESULTS In patients without injury to the tibiofibular syndesmosis, the application of axial load and forced foot and ankle positions showed statistically significant differences on the distal tibiofibular measurements between the stressed and the relaxed position, it also showed interindividual variability : SA (median = 4.12 [IQR = 2.42, 6.63]) (p < 0.001), ADD (0.67 [0.14, 0.67]) (p < 0.001), MDD(0.45, [0.05, 0.9]) (p < 0.001), PDD (0.73 [-0.05, 0.73]) (p < 0.002). However, it did not detect statistically significant differences when the tibiofibular differences between the stressed and the relaxed position in one ankle were compared with the contralateral side: SA (-0.14, SD = 4.33 [95% CI = -2.53, 2.26]), ADD (-0.42, 1.08 [-1.02, 0.18]), MDD (0.29, 0.54 [-0.01, 0.59]), PDD (-0.1, 1.42 [-0.89, 0.68]). Interobserver reliability showed an Intraclass correlation coefficient of 0.990 [95% CI = 0.972, 0.997]. CONCLUSIONS Wide interindividual variability was observed in all syndesmotic measurements, but no statistically significant differences were found when comparing one ankle to the contralateral side. Measuring syndesmosis alignment parameters, may only be of value, if those are compared to the contralateral ankle.
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Affiliation(s)
| | | | | | - Sergio Tejero
- Foot Ankle Unit University Hospital Virgen del Rocío, Seville, Spain; University of Seville, Spain.
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23
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Tomás R, Visco CJ. Management of Acute Ankle Sprains in the Athlete. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-021-00336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Bailowitz Z, Visco CJ, Christen K, Ahmad CS. Diagnostic Musculoskeletal Ultrasound for the Acute Evaluation and Management of Soccer Players. Curr Sports Med Rep 2021; 20:525-530. [PMID: 34622817 DOI: 10.1249/jsr.0000000000000890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Musculoskeletal ultrasound (US) has many applications in the care of athletes. This article reviews the current literature and identifies research gaps regarding musculoskeletal US in the athletic training room setting to evaluate and manage soccer players. The best evidence for US in the training room setting is for diagnosis and prognosis of muscle injuries, where studies show that it is equivalent to other imaging modalities. US also has been used for injury risk prediction, although the data are mixed. Many applications of US are described in other sport settings and may have crossover applications to soccer.
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Affiliation(s)
- Zachary Bailowitz
- Department of Orthopedics, Podiatry, and Sports Medicine, Kaiser Permanente, Oakland, CA
| | - Christopher J Visco
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY
| | | | - Christopher S Ahmad
- Department of Orthopedics, Columbia University Irving Medical Center, New York, NY
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25
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Netterström-Wedin F, Matthews M, Bleakley C. Diagnostic Accuracy of Clinical Tests Assessing Ligamentous Injury of the Talocrural and Subtalar Joints: A Systematic Review With Meta-Analysis. Sports Health 2021; 14:336-347. [PMID: 34286639 PMCID: PMC9109591 DOI: 10.1177/19417381211029953] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Context: Ankle sprains are the most common acute musculoskeletal injury. Clinical tests represent the first opportunity to assess the sprain’s severity, but no systematic review has compared these tests to contemporary reference standards. Objective: To determine the diagnostic accuracy of clinical tests assessing the talocrural and subtalar joint ligaments after ankle sprain. Data Sources: CINAHL, EMBASE, MEDLINE, hand-searching, and PubMed-related article searches (inception to November 18, 2020). Study Selection: Eligible diagnostic studies compared clinical examination (palpation, joint laxity) against imaging or surgery. Studies at a high risk of bias or with high concerns regarding applicability on Quality Assessment of Diagnostic Accuracy Studies-2 were excluded from the meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3a. Data Extraction: True-positive, false-negative, false-positive, and true-negative findings were extracted to calculate sensitivity, specificity, and likelihood ratios. If ordinal data were reported, these were extracted to calculate Cohen’s kappa. Results: A total of 14 studies met the inclusion criteria (6302 observations; 9 clinical tests). No test had both sensitivity and specificity exceeding 90%. Palpation of the anterior talofibular ligament is highly sensitive (sensitivity 95%-100%; specificity 0%-32%; min-max; n = 6) but less so for the calcaneofibular ligament (sensitivity 49%-100%; specificity 26%-79%; min-max; n = 6). Pooled data from 6 studies (885 observations) found a low sensitivity (54%; 95% CI 35%-71%) but high specificity (87%; 95% CI 63%-96%) for the anterior drawer test. Conclusion: The anterior talofibular ligament is best assessed using a cluster of palpation (rule out), and anterior drawer testing (rule in). The talar tilt test can rule in injury to the calcaneofibular ligament, but a sensitive clinical test for the ligament is lacking. It is unclear if ligamentous injury grading can be done beyond the binary (injured vs uninjured), and clinical tests of the subtalar joint ligaments are not well researched. The generalizability of our findings is limited by insufficient reporting on blinding and poor study quality. Registration: Prospero ID: CRD42020187848. Data Availability: Data are available in a public, open access repository on publication, including our RevMan file and the CSV file used for meta-analysis: http://doi.org/10.5281/zenodo.4917138
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Affiliation(s)
| | - Mark Matthews
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
| | - Chris Bleakley
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Jordanstown Campus, Antrim, UK
- Chris Bleakley, PhD, Ulster University, Jordanstown Campus, Room 01F118, Shore Road, Newtownabbey Co, Antrim BT37 0QB, UK ()
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