Skip to main content

Advertisement

SpringerLink
Log in

Ankle ultrasound for detecting anterior talofibular ligament tear using operative finding as reference standard: a systematic review and meta-analysis

  • Review Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the diagnostic accuracy of ankle ultrasound for detection of anterior talofibular ligament (ATFL) tear with a reference standard of operative finding.

Methods

A computerized search of PubMed and EMBASE databases was performed to identify relevant original articles on ankle ultrasound for ATFL tear. The pooled proportions of the diagnostic accuracy estimates were assessed using random-effects modeling. We also assessed pooled proportions of the diagnostic accuracy according to injury stage (acute or chronic) and severity of injury (complete or partial). Heterogeneity among studies was determined using the inconsistency index (I2). Meta-regression analyses were performed to evaluate the potential sources of heterogeneity.

Results

Ten studies were included. The pooled proportion of the diagnostic accuracy of ankle ultrasound for ATFL was 0.95 (95% confidence interval [CI] 0.88–0.98). In subgroup analysis, the pooled proportion of the diagnostic accuracy of ankle ultrasound for acute ATFL tear was 0.92 (95% CI 0.85–0.95). The pooled proportion of the diagnostic accuracy of ankle ultrasound for chronic ATFL tear was 0.96 (95% CI 0.84–0.99). The pooled proportions of the diagnostic accuracy for complete and partial ATFL tear were 0.82 (95% CI 0.72–0.89) and 0.88 (95% CI 0.70–0.96), respectively. In the meta-regression analyses, the inclusion of pediatric patients was only significantly different (p = 0.007).

Conclusions

Ankle ultrasound may be a useful diagnostic modality in the detection of ATFL tear in adults and children, regardless of injury stage and severity. For correct diagnosis of ATFL tear, a high-frequency ultrasound probe and sufficient experience of the examiner are mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Langner I, Frank M, Kuehn JP, Hinz P, Ekkernkamp A, Hosten N, et al. Acute inversion injury of the ankle without radiological abnormalities: assessment with high-field MR imaging and correlation of findings with clinical outcome. Skeletal Radiol. 2011;40(4):423–30. https://doi.org/10.1007/s00256-010-1017-y.

    Article  PubMed  Google Scholar 

  2. Czajka CM, Tran E, Cai AN, DiPreta JA. Ankle sprains and instability. Med Clin North Am. 2014;98(2):313–29. https://doi.org/10.1016/j.mcna.2013.11.003.

    Article  PubMed  Google Scholar 

  3. Salat P, Le V, Veljkovic A, Cresswell ME. Imaging in foot and ankle instability. Foot Ankle Clin. 2018;23(4):499–522 e28. https://doi.org/10.1016/j.fcl.2018.07.011.

    Article  PubMed  Google Scholar 

  4. Scillia AJ, Pierce TP, Issa K, Wright C, Callaghan JJ, Festa A, et al. Low ankle sprains: a current review of diagnosis and treatment. Surg Technol Int. 2017;30:411–4.

    PubMed  Google Scholar 

  5. Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC. Management of ankle sprains. Am Fam Phys. 2001;63(1):93–104.

    CAS  Google Scholar 

  6. Lee SH, Yun SJ. The feasibility of point-of-care ankle ultrasound examination in patients with recurrent ankle sprain and chronic ankle instability: comparison with magnetic resonance imaging. Injury. 2017;48(10):2323–8. https://doi.org/10.1016/j.injury.2017.07.015.

    Article  PubMed  Google Scholar 

  7. Alves T, Dong Q, Jacobson J, Yablon C, Gandikota G. Normal and injured ankle ligaments on ultrasonography with magnetic resonance imaging correlation. J Ultrasound Med. 2018;5:6. https://doi.org/10.1002/jum.14716.

    Article  Google Scholar 

  8. Pinto A, Pinto F, Faggian A, Rubini G, Caranci F, Macarini L, et al. Sources of error in emergency ultrasonography. Crit Ultrasound J. 2013;5(Suppl 1):S1. https://doi.org/10.1186/2036-7902-5-S1-S1.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100.

    Article  PubMed  PubMed Central  Google Scholar 

  10. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, the P-DTAG, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA. 2018;319(4):388–96. https://doi.org/10.1001/jama.2017.19163.

    Article  PubMed  Google Scholar 

  11. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36. https://doi.org/10.7326/0003-4819-155-8-201110180-00009.

    Article  PubMed  Google Scholar 

  12. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2):97–111. https://doi.org/10.1002/jrsm.12.

    Article  PubMed  Google Scholar 

  13. DerSimonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials. 2007;28(2):105–14. https://doi.org/10.1016/j.cct.2006.04.004.

    Article  PubMed  Google Scholar 

  14. Higgins JPT, Green S (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.

  15. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. https://doi.org/10.1136/bmj.327.7414.557.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.

    Article  CAS  PubMed  Google Scholar 

  18. Margetic P, Pavic R. Comparative assessment of the acute ankle injury by ultrasound and magnetic resonance. Coll Antropol. 2012;36(2):605–10.

    PubMed  Google Scholar 

  19. Croy T, Saliba S, Saliba E, Anderson MW, Hertel J. Differences in lateral ankle laxity measured via stress ultrasonography in individuals with chronic ankle instability, ankle sprain copers, and healthy individuals. J Orthop Sports Phys Ther. 2012;42(7):593–600. https://doi.org/10.2519/jospt.2012.3923.

    Article  PubMed  Google Scholar 

  20. Croy T, Saliba S, Saliba E, Anderson MW, Hertel J. Talofibular interval changes after acute ankle sprain: a stress ultrasonography study of ankle laxity. J Sport Rehabil. 2013;22(4):257–63.

    Article  PubMed  Google Scholar 

  21. Hsu CC, Tsai WC, Chen CPC, Chen MJL, Tang SFT, Shih L. Ultrasonographic examination for inversion ankle sprains associated with osseous injuries. Am J Phys Med Rehabil. 2006;85(10):785–92. https://doi.org/10.1097/01.phm.0000237875.90254.4e.

    Article  PubMed  Google Scholar 

  22. Liu K, Gustavsen G, Royer T, Wikstrom EA, Glutting J, Kaminski TW. Increased ligament thickness in previously sprained ankles as measured by musculoskeletal ultrasound. J Athl Train. 2015;50(2):193–8. https://doi.org/10.4085/1062-6050-49.3.77.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Maeda M, Maeda N, Takaoka T, Tanaka Y. Sonographic findings of chondral avulsion fractures of the lateral ankle ligaments in children. J Ultrasound Med. 2017;36(2):421–32. https://doi.org/10.7863/ultra.15.09008.

    Article  PubMed  Google Scholar 

  24. Mizrahi DJ, Nazarian LN, Parker L. Evaluation of the anterior talofibular ligament via stress sonography in asymptomatic and symptomatic populations. J Ultrasound Med. 2018;37(8):1957–63. https://doi.org/10.1002/jum.14542.

    Article  PubMed  Google Scholar 

  25. Yildizgoren MT, Velioglu O, Demetgul O, Turhanoglu AD. Assessment of the anterior talofibular ligament thickness in patients with chronic stroke: an ultrasonographic study. J Med Ultrasound. 2017;25(3):145–9. https://doi.org/10.1016/j.jmu.2017.03.001.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Guillodo Y, Riban P, Guennoc X, Dubrana F, Saraux A. Usefulness of ultrasonographic detection of talocrural effusion in ankle sprains. J Ultrasound Med. 2007;26(6):831–6.

    Article  PubMed  Google Scholar 

  27. Farley FA, Kuhns L, Jacobson JA, DiPietro M. Ultrasound examination of ankle injuries in children. J Pediatr Orthop. 2001;21(5):604–7.

    CAS  PubMed  Google Scholar 

  28. Gremeaux V, Coudreuse JM, Collado H, Cohen M, Bensoussan L, Fondarai J, et al. Comparative study of clinical and ultrasonographic evaluation of lateral collateral ligament sprains of the ankle. J Sports Med Phys Fitness. 2009;49(3):285–91.

    CAS  PubMed  Google Scholar 

  29. Gün C, Ünlüer EE, Vandenberk N, Karagöz A, Sentürk GO, Oyar O. Bedside ultrasonography by emergency physicians for anterior talofibular ligament injury. J Emerg Trauma Shock. 2013;6(3):195–8. https://doi.org/10.4103/0974-2700.115340.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jones S, Colaco K, Fischer J, Stimec J, Kwan C, Boutis K. Accuracy of point-of-care ultrasonography for pediatric ankle sprain injuries. Pediatr Emerg Care. 2018;34(12):842–7. https://doi.org/10.1097/pec.0000000000001130.

    Article  PubMed  Google Scholar 

  31. Lee KT, Park YU, Jegal H, Park JW, Choi JP, Kim JS. New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound. Knee Surg Sports Traumatol Arthrosc. 2014;22(7):1701–7. https://doi.org/10.1007/s00167-013-2690-x.

    Article  PubMed  Google Scholar 

  32. Milz P, Milz S, Steinborn M, Mittlmeier T, Putz R, Reiser M. Lateral ankle ligaments and tibiofibular syndesmosis. 13-MHz high-frequency sonography and MRI compared in 20 patients. Acta Orthop Scand. 1998;69(1):51–5.

    Article  CAS  PubMed  Google Scholar 

  33. Wiebking U, Pacha TO, Jagodzinski M. An accuracy evaluation of clinical, arthrometric, and stress-sonographic acute ankle instability examinations. Foot Ankle Surg. 2015;21(1):42–8. https://doi.org/10.1016/j.fas.2014.09.006.

    Article  PubMed  Google Scholar 

  34. Campbell DG, Menz A, Isaacs J. Dynamic ankle ultrasonography. A new imaging technique for acute ankle ligament injuries. Am J Sports Med. 1994;22(6):855–8. https://doi.org/10.1177/036354659402200620.

    Article  CAS  PubMed  Google Scholar 

  35. Cheng Y, Cai Y, Wang Y. Value of ultrasonography for detecting chronic injury of the lateral ligaments of the ankle joint compared with ultrasonography findings. Br J Radiol. 2014;87(1033):20130406. https://doi.org/10.1259/bjr.20130406.

    Article  CAS  PubMed  Google Scholar 

  36. Cho JH, Lee DH, Song HK, Bang JY, Lee KT, Park YU. Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1022–8. https://doi.org/10.1007/s00167-015-3828-9.

    Article  PubMed  Google Scholar 

  37. Elkaïm M, Thès A, Lopes R, Andrieu M, Cordier G, Molinier F, et al. Agreement between arthroscopic and imaging study findings in chronic anterior talo-fibular ligament injuries. Orthop Traumatol Surg Res. 2018;104(8):S213–8. https://doi.org/10.1016/j.otsr.2018.09.008.

    Article  PubMed  Google Scholar 

  38. Friedrich JM, Schnarkowski P, Rubenacker S, Wallner B. Ultrasonography of capsular morphology in normal and traumatic ankle joints. J Clin Ultrasound. 1993;21(3):179–87.

    Article  CAS  PubMed  Google Scholar 

  39. Hua Y, Yang Y, Chen S, Cai Y. Ultrasound examination for the diagnosis of chronic anterior talofibular ligament injury. Acta Radiol. 2012;53(10):1142–5. https://doi.org/10.1258/ar.2012.120171.

    Article  PubMed  Google Scholar 

  40. McCarthy CL, Wilson DJ, Coltman TP. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging. Skeletal Radiol. 2008;37(3):209–16. https://doi.org/10.1007/s00256-007-0411-6.

    Article  CAS  PubMed  Google Scholar 

  41. Oae K, Takao M, Uchio Y, Ochi M. Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging. Skeletal Radiol. 2010;39(1):41–7. https://doi.org/10.1007/s00256-009-0767-x.

    Article  PubMed  Google Scholar 

  42. Szczepaniak J, Ciszkowska-Łysoń B, Śmigielski R, Zdanowicz U. Wartość badania ultrasonograficznego w ocenie świeżych uszkodzeń więzadła skokowo-strzałkowego przedniego u dzieci. J Ultrasonography. 2015;15(62):259–66. https://doi.org/10.15557/jou.2015.0022.

    Article  Google Scholar 

  43. van Dijk CN, Mol BW, Lim LS, Marti RK, Bossuyt PM. Diagnosis of ligament rupture of the ankle joint. Physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma. Acta Orthop Scand. 1996;67(6):566–70.

    Article  PubMed  Google Scholar 

  44. Raatikainen T, Putkonen M, Puranen J. Arthrography, clinical examination, and stress radiograph in the diagnosis of acute injury to the lateral ligaments of the ankle. Am J Sports Med. 1992;20(1):2–6. https://doi.org/10.1177/036354659202000102.

    Article  CAS  PubMed  Google Scholar 

  45. van Dijk CN, Lim LS, Bossuyt PM, Marti RK. Physical examination is sufficient for the diagnosis of sprained ankles. J Bone Jt Surg Br. 1996;78(6):958–62.

    Article  Google Scholar 

  46. De Maeseneer M, Marcelis S, Jager T, Shahabpour M, Van Roy P, Weaver J, et al. Sonography of the normal ankle: a target approach using skeletal reference points. AJR Am J Roentgenol. 2009;192(2):487–95. https://doi.org/10.2214/AJR.08.1316.

    Article  PubMed  Google Scholar 

  47. Glaser F, Friedl W, Welk E. The value of ultrasound in the diagnosis of capsule ligament injuries of the upper ankle joint. Unfallchirurg. 1989;92(11):540–6.

    CAS  PubMed  Google Scholar 

  48. Guo C, Zhu Y, Hu M, Deng L, Xu X. Reliability of measurements on lateral ankle radiographs. BMC Musculoskelet Disord. 2016;17:297. https://doi.org/10.1186/s12891-016-1150-4.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Howard ZD, Noble VE, Marill KA, Sajed D, Rodrigues M, Bertuzzi B, et al. Bedside ultrasound maximizes patient satisfaction. J Emerg Med. 2014;46(1):46–53. https://doi.org/10.1016/j.jemermed.2013.05.044.

    Article  PubMed  Google Scholar 

  50. Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48(3):227–35. https://doi.org/10.1016/j.annemergmed.2006.01.008.

    Article  PubMed  Google Scholar 

  51. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749–57. https://doi.org/10.1056/NEJMra0909487.

    Article  CAS  PubMed  Google Scholar 

  52. Guidelines U. Emergency, point-of-care and clinical ultrasound guidelines in medicine. Ann Emerg Med. 2017;69(5):e27–54. https://doi.org/10.1016/j.annemergmed.2016.08.457.

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea

    Sun Hwa Lee

  2. Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea

    Seong Jong Yun

Authors
  1. Sun Hwa Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seong Jong Yun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seong Jong Yun.

Ethics declarations

Conflict of interest

The Authors declare that there is no conflict of interest.

Human and animal rights statement

This article does not contain any studies with human or animal subjects performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S.H., Yun, S.J. Ankle ultrasound for detecting anterior talofibular ligament tear using operative finding as reference standard: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 46, 73–81 (2020). https://doi.org/10.1007/s00068-019-01169-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-019-01169-3

Keywords

Search

Navigation