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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 4, pp 1022–1028 | Cite as

Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy

  • Jae Ho Cho
  • Doo Hyung Lee
  • Hyung Keun Song
  • Joon Young Bang
  • Kyung Tai Lee
  • Young Uk ParkEmail author
Ankle

Abstract

Purpose

Clinicians frequently diagnose chronic ankle instability using the manual anterior drawer test and stress radiography. However, both examinations can yield incorrect results and do not reveal the extent of ankle instability. Stress ultrasound has been reported to be a new diagnostic tool for the diagnosis of chronic ankle instability. The purpose of this study was to assess the diagnostic value of stress ultrasound for chronic ankle instability compared to the manual anterior drawer test, stress radiography, magnetic resonance imaging (MRI), and arthroscopy.

Methods

Twenty-eight consecutive patients who underwent ankle arthroscopy and subsequent modified Broström repair for treatment of chronic ankle instability were included. The arthroscopic findings were used as the reference standard. A standardized physical examination (manual anterior drawer test), stress radiography, MRI, and stress ultrasound were performed to assess the anterior talofibular ligament (ATFL) prior to operation. Ultrasound images were taken in the resting position and the maximal anterior drawer position.

Results

Grade 3 lateral instability was verified arthroscopically in all 28 cases with a clinical diagnosis (100 %). Twenty-two cases showed grade III instability on the manual anterior drawer test (78.6 %). Twenty-four cases displayed anterior translation exceeding 5 mm on stress radiography (86 %), and talar tilt angle exceeded 15° in three cases (11 %). Nineteen cases displayed a partial chronic tear (change in thickness or signal intensity), and nine cases displayed complete tear on MRI (100 %). Lax and wavy ATFL was evident on stress ultrasound in all cases (100 %). The mean value of the ATFL length was 2.8 ± 0.3 cm for the stressed condition and 2.1 ± 0.2 cm for the resting condition (p < 0.001).

Conclusion

Stress ultrasound may be useful for the diagnosis of chronic ankle instability in addition to the manual anterior drawer test and stress radiography.

Level of evidence

III.

Keywords

Anterior talofibular ligament Chronic ankle instability Stress ultrasound 

Supplementary material

Supplementary material 1 (WMV 1813 kb)

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Jae Ho Cho
    • 1
  • Doo Hyung Lee
    • 1
  • Hyung Keun Song
    • 1
  • Joon Young Bang
    • 1
  • Kyung Tai Lee
    • 2
  • Young Uk Park
    • 1
    Email author
  1. 1.Department of Orthopedic SurgeryAjou University Hospital, Ajou University School of MedicineSuwonRepublic of Korea
  2. 2.Foot and Ankle ServiceKT Lee’s Orthopedic HospitalSeoulRepublic of Korea

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