Can virtual touch tissue imaging quantification be a reliable method to detect anterior talofibular ligament type I injury at the acute, subacute, and chronic stages?

Abstract

Background: Anterior talofibular ligament (ATFL) injury affects ankle joint stability. To date, very few studies have examined tissue stiffness changes inside injured ligaments. Virtual touch tissue imaging quantification (VTIQ) allows for the non-invasive quantitative measurement of tissue stiffness. The present study aimed to examine the efficacy of VTIQ as a method for detecting ligament injury.Methods: A total of 206 patients diagnosed with unilateral ATFL type I injury (81 acute cases, 69 subacute cases, and 56 chronic cases) were reviewed retrospectively. Shear wave velocity (SWV) values were collected from both the injured and non-affected sides of the ATFL using a virtual touch tissue imaging quantification technique (ACUSON Oxana 2, Siemens Medical Solutions USA, Inc.). Results:The average SWV of injured ATFL was 4.09±1.15 m/s in the acute group, 5.60±1.39 m/s in the subacute group, and 7.74±1.44 m/s in the chronic group (P<0.001). The SWV values of the ATFL on the nonaffected side were almost identical (acute 7.50±1.12 m/s, subacute 7.53±1.06 m/s, and chronic 7.61±1.30 m/s; P>0.05). The injured ATFL had a significantly lower SWV value than the non-affected ATFL in the acute and subacute groups (P<0.001); however, there was no significant difference in the chronic group (P>0.05).Concerning the validity of SWV as a predictor of acute and subacute ATFL injury, the receiver operator characteristics curve analysis showed that the best cut-off point for SWV was 6.165 m/s, with 84.3% sensitivity, 88.5% specificity, and an area under the curve of 0.93 (95% CI, 0.90-0.95).Conclusions: VTIQ is a reliable sonographic method for detecting acute and subacute ATFL type I injury.

The effect of thickness and elastic modulus of the anterior talofibular ligament on anterior ankle joint stiffness: A subject-specific finite element study

“…The ratio of the apparent elastic modulus obtained from elastography to that measured from the conventional mechanical test varies in different tissues and perhaps increases with the increase of soft tissue stiffness. Previous literature about elastography assessment of ATFL have reported SWV values ranging between 1.79 m/s ( Hotfiel et al, 2018 ) and 7.6 m/s ( Chen et al, 2021 ) for the healthy controls. The mean SWV value of ATFL in the control group in this study was within the variation range of the literature data mentioned before.…”

“…An observational study about re-sprains during the 12 months of follow-up after an initial ankle sprain suggested that up to 55% of individuals sustained instability, and 28% of the participants reported at least one re-sprain (van Middelkoop et al, 2012). Previous studies have observed ATFL thickness differences in ligament injury, which can be detected using ultrasound in B-mode and MRI but without clear diagnosis criteria of ligament thickness (Kanamoto et al, 2014;Chen et al, 2021). The diagnostic criterion for the acute posterior cruciate ligament injury was larger than 6.5 mm (Wang et al, 2017).…”

“…Studies have reported various pathological features of ATFL integrity assessed through MRI and arthroscopic surgery, with some cases showing as thin or absent, while others exhibiting thickening ( Kanamoto et al, 2014 ; Jung et al, 2017 ). The shear wave velocity (SWV) in acoustic radiation force impulse (ARFI) imaging, which represents the stiffness of the materials, showed that injured ATFL in the acute and subacute groups were significantly softer than those of non-affected ATFL, while the ATFL in the chronic group were slightly stiffer than that of the non-affected ATFL ( Chen et al, 2021 ).…”

Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament

“…Non-invasive virtual touch tissue imaging quantification, a novel ultrasonic palpation method, can identify the hardness difference of acute type I ATFL injuries and evaluate ligament elasticity. These are all new methods for quantifying ankle ligament stiffness and diagnosing and monitoring ATFL injury[ 31 ]. According to the examination results, physicians can time the treatment plan appropriately, develop a more effective rehabilitation plan, further improve the outcomes, promote ATFL injury healing, accelerate ankle joint function recovery, and reduce the occurrence of complications.…”

Diagnostic value of shear wave elastography quantification combined with conventional ultrasound in salivary gland tumors

“…At present, ultrasonic techniques that can quantitatively measure tissue hardness include virtual touch tissue imaging (VTIQ) and SWE. They both are non-invasive technologies that can quantitatively evaluate the elasticity of the mass by measuring average shear wave velocity (SWV) of a region of interest (ROI) in the mass ( 10 , 11 ). SWE can convert SWV into Young’s modulus, and the stiffness of the mass is expressed in Kpa.…”