An accuracy evaluation of clinical, arthrometric, and stress-sonographic acute ankle instability examinations

Wiebking, Ulrich; Pacha, Tarek Omar; Jagodzinski, Michael

doi:10.1016/j.fas.2014.09.006

Cited by 23 publications

(20 citation statements)

References 20 publications

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“…After removing 34 duplicates, we reviewed 193 titles and abstracts, then excluded 166 studies for the following reasons: case reports/letters/editorials/conference abstracts (n = 24); review articles/guidelines/consensus statements (n = 24); not in the field of interest (n = 116); and not human study (n = 2). After reviewing the full text of 27 eligible articles, we excluded 17 for the following reasons: studies with insufficient data to build 2 × 2 tables (n = 11) (20–30); studies focusing only on the diagnostic performance of indirect signs of ankle ligament tear (n = 1) (31); and studies without use of surgical finding or MRI as the reference standard (n = 5) (6,8,32–34). Ultimately, 10 original research articles (19,35–43) including a total of 380 patients were included in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic performance of ankle ultrasound for diagnosing anterior talofibular and calcaneofibular ligament injuries: a meta-analysis

2019

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Background Ankle ultrasound imaging could be an option with higher priority due to its lack of radiation, and cost- and time-effectiveness. However, previous studies regarding anterior tibiofibular ligament and calcaneofibular ligament injuries have shown varied results. Purpose To evaluate the diagnostic performance of ankle ultrasound for anterior tibiofibular ligament and calcaneofibular ligament injuries. Material and Methods PubMed and EMBASE databases were searched for diagnostic accuracy studies that used ultrasound for diagnosing anterior tibiofibular ligament and calcaneofibular ligament injuries. Bivariate and hierarchical summary receiver operating characteristic modeling were used to evaluate diagnostic performance. Subgroup analysis was performed using studies according to severity of the injury (complete and partial anterior tibiofibular ligament tear). We performed meta-regression analyses for heterogeneity exploration. Results Ten articles involving a total of 380 patients were included. For anterior tibiofibular ligament injury, the summary sensitivity, summary specificity, and area under the hierarchical summary receiver operating characteristic curve (AUC) were 0.99, 0.92, and 0.99, respectively. For calcaneofibular ligament injury, the summary sensitivity, summary specificity, and AUC were 0.95, 0.99, and 0.95, respectively. In subgroup analysis, for complete anterior tibiofibular ligament tear, the summary sensitivity, summary specificity, and AUC were 0.96, 0.82, and 0.96, respectively. For partial anterior tibiofibular ligament tear, the summary sensitivity, summary specificity, and AUC were 0.90, 0.82, and 0.93, respectively. Among the various potential covariates, proportion of anterior tibiofibular ligament tear, ultrasound interpreter, and reference standard were associated with specificity heterogeneity. Conclusion Ankle ultrasound demonstrates high diagnostic performance in the diagnosis of anterior tibiofibular ligament and calcaneofibular ligament injuries. We recommend ultrasound performed by a musculoskeletal radiologist as a first-line diagnostic tool to diagnose anterior tibiofibular ligament and calcaneofibular ligament injuries.

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Section: Resultsmentioning

confidence: 99%

Diagnostic performance of ankle ultrasound for diagnosing anterior talofibular and calcaneofibular ligament injuries: a meta-analysis

2019

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“…Four articles were excluded because they were pilot studies focusing on moment arm calculation, force measurements or kinematic analysis with no connection to CAI . Two articles were excluded because their focus was on the acute setting …”

Section: Resultsmentioning

confidence: 99%

In vivo arthrometer measurements of mechanical ankle instability—A systematic review

Lohrer²,

Gollhofer

et al. 2019

Journal Orthopaedic Research

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Chronic ankle instability is caused by functional and/or mechanical deficits. To differentiate the two entities, mechanical ankle instability can be assessed using arthrometers. The measurement of mechanical instability is essential, since it can only be addressed surgically. The aim of this systematic literature review was to find out whether chronic mechanical ankle instability could be adequately and objectively assessed using in vivo arthrometer measurements. Articles were included if the main focus was to evaluate the contribution of mechanical deficits to chronic ankle instability and if they provided sufficient description of the device used. This systematic review was performed according to the PRISMA-recommendations. Initially 47 articles were screened for eligibility, of which 33 studies reporting 10 different devices were included. While the reliability of the measurements was mostly good to excellent, only two studies aimed to assess the sensitivity and specificity of their results in regard to chronic ankle instability. Several devices reported conflicting results about mechanical deficits. In summary, this systematic review reveals a substantial deficit in diagnostic accuracy when assessing mechanical ankle instability in a clinical setting. Biases in recruiting and classification of participants raise the question whether the two entities of functional and mechanical ankle instability are properly defined. Clinical Significance: In recent years, this may have led to a misinterpretation of mechanical deficits and the subsequent need for surgical intervention. ß 2019

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“…US is not typically the next line of evaluation of syndesmotic injuries. Although some studies have suggested focused US could be beneficial for ligamentous evaluation, others have shown limited utility in lateral ankle ligament sprains [75].…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

ACR Appropriateness Criteria® Acute Trauma to the Ankle

Smith

Chang

et al. 2020

Journal of the American College of Radiology

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Acute injuries to the ankle are frequently encountered in the setting of the emergency room, sport, and general practice. This ACR Appropriateness Criteria defines best practices for imaging evaluation for several variants of patients presenting with acute ankle trauma. The variants include scenarios when Ottawa Rules can be evaluated, when there are exclusionary criteria, when Ottawa Rules cannot be evaluated, as well as specific injuries. Clinical scenarios are followed by the imaging choices and their appropriateness with an accompanying narrative explanation to help physicians to order the most appropriate imaging test.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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An accuracy evaluation of clinical, arthrometric, and stress-sonographic acute ankle instability examinations

Cited by 23 publications

References 20 publications

Diagnostic performance of ankle ultrasound for diagnosing anterior talofibular and calcaneofibular ligament injuries: a meta-analysis

Diagnostic performance of ankle ultrasound for diagnosing anterior talofibular and calcaneofibular ligament injuries: a meta-analysis

In vivo arthrometer measurements of mechanical ankle instability—A systematic review

ACR Appropriateness Criteria® Acute Trauma to the Ankle

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