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

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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References

  1. Alparslan L, Chiodo CP (2008) Lateral ankle instability: MR imaging of associated injuries and surgical treatment procedures. Semin Musculoskelet Radiol 12:346–358

    Article  PubMed  Google Scholar 

  2. Aradi AJ, Wong J, Walsh M (1988) The dimple sign of a ruptured lateral ligament of the ankle: brief report. J Bone Joint Surg Br 70:327–328

    CAS  PubMed  Google Scholar 

  3. Balduini FC, Vegso JJ, Torg JS, Torg E (1987) Management and rehabilitation of ligamentous injuries to the ankle. Sports Med 4:364–380

    Article  CAS  PubMed  Google Scholar 

  4. Brooks SC, Potter BT, Rainey JB (1981) Treatment for partial tears of the lateral ligament of the ankle: a prospective trial. Br Med J (Clin Res Ed) 282:606–607

    Article  CAS  Google Scholar 

  5. Campbell DG, Menz A, Isaacs J (1994) Dynamic ankle ultrasonography. A new imaging technique for acute ankle ligament injuries. Am J Sports Med 22:855–858

    Article  CAS  PubMed  Google Scholar 

  6. Chandnani VP, Harper MT, Ficke JR, Gagliardi JA, Rolling L, Christensen KP, Hansen MF (1994) Chronic ankle instability: evaluation with MR arthrography, MR imaging, and stress radiography. Radiology 192:189–194

    Article  CAS  PubMed  Google Scholar 

  7. Croy T, Saliba SA, Saliba E, Anderson MW, Hertel J (2012) 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 42:593–600

    Article  PubMed  Google Scholar 

  8. De Maeseneer M, Marcelis S, Jager T, Shahabpour M, Van Roy P, Weaver J, Jacobson JA (2009) Sonography of the normal ankle: a target approach using skeletal reference points. AJR Am J Roentgenol 192:487–495

    Article  PubMed  Google Scholar 

  9. Dimmick S, Kennedy D, Daunt N (2008) Evaluation of thickness and appearance of anterior talofibular and calcaneofibular ligaments in normal versus abnormal ankles with MRI. J Med Imaging Radiat Oncol 52:559–563

    Article  CAS  PubMed  Google Scholar 

  10. Evans GA, Hardcastle P, Frenyo AD (1984) Acute rupture of the lateral ligament of the ankle. To suture or not to suture? J Bone Joint Surg Br 66:209–212

    CAS  PubMed  Google Scholar 

  11. Fujii T, Luo ZP, Kitaoka HB, An KN (2000) The manual stress test may not be sufficient to differentiate ankle ligament injuries. Clin Biomech (Bristol, Avon) 15:619–623

    Article  CAS  Google Scholar 

  12. Glaser F, Friedl W, Welk E (1989) The value of ultrasound in the diagnosis of capsule ligament injuries of the upper ankle joint. Unfallchirurg 92:540–546

    CAS  PubMed  Google Scholar 

  13. Glasgow M, Jackson A, Jamieson AM (1980) Instability of the ankle after injury to the lateral ligament. J Bone Joint Surg Br 62-B:196–200

    CAS  PubMed  Google Scholar 

  14. Guillodo Y, Varache S, Saraux A (2010) Value of ultrasonography for detecting ligament damage in athletes with chronic ankle instability compared to computed arthrotomography. Foot Ankle Spec 3:331–334

    Article  PubMed  Google Scholar 

  15. Hintermann B, Boss A, Schafer D (2002) Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med 30:402–409

    PubMed  Google Scholar 

  16. Kannus P, Renstrom P (1991) Treatment for acute tears of the lateral ligaments of the ankle. Operation, cast, or early controlled mobilization. J Bone Joint Surg Am 73:305–312

    CAS  PubMed  Google Scholar 

  17. Lee KT, Park YU, Jegal H, Park JW, Choi JP, Kim JS (2014) New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound. Knee Surg Sports Traumatol Arthrosc 22:1701–1707

    Article  PubMed  Google Scholar 

  18. Lee KT, Park YU, Kim JS, Kim JB, Kim KC, Kang SK (2011) Long-term results after modified Brostrom procedure without calcaneofibular ligament reconstruction. Foot Ankle Int 32:153–157

    Article  PubMed  Google Scholar 

  19. Oae K, Takao M, Uchio Y, Ochi M (2010) Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging. Skelet Radiol 39:41–47

    Article  Google Scholar 

  20. Pijnenburg AC, Bogaard K, Krips R, Marti RK, Bossuyt PM, van Dijk CN (2003) Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial. J Bone Joint Surg Br 85:525–530

    Article  CAS  PubMed  Google Scholar 

  21. Rijke AM (1995) MR imaging versus stress radiography in the evaluation of chronic ankle instability. Radiology 196:580–581

    Article  CAS  PubMed  Google Scholar 

  22. Schneck CD, Mesgarzadeh M, Bonakdarpour A (1992) MR imaging of the most commonly injured ankle ligaments. Part II. Ligament injuries. Radiology 184:507–512

    Article  CAS  PubMed  Google Scholar 

  23. Seligson D, Gassman J, Pope M (1980) Ankle instability: evaluation of the lateral ligaments. Am J Sports Med 8:39–42

    Article  CAS  PubMed  Google Scholar 

  24. Sheehan FT, Seisler AR, Siegel KL (2007) In vivo talocrural and subtalar kinematics: a non-invasive 3D dynamic MRI study. Foot Ankle Int 28:323–335

    Article  PubMed  Google Scholar 

  25. Sisson L, Croy T, Saliba S, Hertel J (2011) Comparison of ankle arthrometry to stress ultrasound imaging in the assessment of ankle laxity in healthy adults. Int J Sports Phys Ther 6:297–305

    PubMed  PubMed Central  Google Scholar 

  26. Tohyama H, Yasuda K, Ohkoshi Y, Beynnon BD, Renstrom PA (2003) Anterior drawer test for acute anterior talofibular ligament injuries of the ankle. How much load should be applied during the test? Am J Sports Med 31:226–232

    PubMed  Google Scholar 

  27. Valderrabano V, Hintermann B, Horisberger M, Fung TS (2006) Ligamentous posttraumatic ankle osteoarthritis. Am J Sports Med 34:612–620

    Article  PubMed  Google Scholar 

  28. van Dijk CN, Mol BW, Lim LS, Marti RK, Bossuyt PM (1996) 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 67:566–570

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea

    Jae Ho Cho, Doo Hyung Lee, Hyung Keun Song, Joon Young Bang & Young Uk Park

  2. Foot and Ankle Service, KT Lee’s Orthopedic Hospital, Seoul, Republic of Korea

    Kyung Tai Lee

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  1. Jae Ho Cho
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  2. Doo Hyung Lee
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  3. Hyung Keun Song
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Correspondence to Young Uk Park.

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Cho, J.H., Lee, D.H., Song, H.K. et al. 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 24, 1022–1028 (2016). https://doi.org/10.1007/s00167-015-3828-9

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  • DOI: https://doi.org/10.1007/s00167-015-3828-9

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