Ultrasound Characteristics of Foot and Ankle Structures in Healthy, Coper, and Chronically Unstable Ankles

Background: The lateral ankle ligament complex is the most frequently injured ligament secondary to strong ankle inversion movement during lateral ankle sprains (LAS). Among these injuries, anterior talofibular ligament (ATFL) injury is the most frequent condition (present in 66-85% of such injuries). The purpose of this research was to use magnetic resonance imaging (MRI) to determine the association between ankle tendon, ligament, and joint conditions and ATFL injuries.Methods: A case-control MRI study was carried out to compare the presence of ankle muscle, tendon, ligament, and joint conditions in patients with injured ATFLs (case group; n=25) and non-injured ATFLs (control group; n=25).Results: Achilles tendinopathy was present in 1/25 (4%) patients with injured ATFLs and 7/25 (28%) noninjured ATFL subjects (P=0.048). Injured calcaneofibular ligaments (CFLs) were present in 19/25 (76%) patients with injured ATFLs and 1/25 (4%) non-injured ATFL subjects (P<0.001). Finally, injured tibiotalar joints were present in 16/25 (64%) patients with injured ATFLs and 5/25 (20%) non-injured ATFL subjects (P=0.002). Other musculoskeletal structure injuries occurred at similar rates between patients with injured ATFLs and those with non-injured ATLFs (P≥0.05).Conclusions: Patients with ATFL injuries showed a greater presence of CFL and tibiotalar joint injuries than subjects with non-injured ATFLs.

Becerro‐de‐Bengoa‐Vallejo

Section: Non-association Between Tendon Ligament and Joint Conditions And Atfl Injurysupporting

confidence: 92%

Association between anterior talofibular ligament injury and ankle tendon, ligament, and joint conditions revealed by magnetic resonance imaging

Casado-Hernández

Losa‐Iglesias

et al. 2021

“…The thickening of the CFL has been considered to be a significant morphologic parameter of an inflammatory hypertrophic CFL. However, Abdeen et al reported that ultrasound (US)-guided CFLT diagnostic sensitivity and specificity were 47% and 83%, respectively, with an accuracy of 72% (24). Moreover, we found several difficulties associated with measuring CFLT.…”

Section: Discussionmentioning

confidence: 61%

Prediction of suspicious ankle instability using the calcaneofibular ligament cross-sectional area

Park¹,

Han²,

Kim³

et al. 2021

Background: An injured calcaneofibular ligament (CFL) is a major cause of ankle instability (AI). Previous research has demonstrated that the thickness of the calcaneofibular ligament (CFLT) is correlated with higher-grade sprains and ankle instability. However, inflammatory hypertrophy is distinct from ligament thickness; accordingly, we considered that the calcaneofibular ligament cross-sectional area (CFLCSA) as a potential morphological parameter to analyze inflammatory CFL. We hypothesized that the CFLCSA was a key morphologic parameter in AI diagnosis. Methods:We gathered the CFL data of 26 AI patients and 25 control subjects who had undergone ankle magnetic resonance imaging (A-MRI), and it had revealed no evidence of AI. Ankle level T1-weighted coronal A-MRI images were acquired. Using our image analysis program (INFINITT PACS), we analyzed the CFLT and CFLCSA at the CFL on the A-MRI. The CFLCSA was measured as the whole ligament cross-sectional area of the CFL that was most hypertrophied in the transverse A-MR images. The CFLT was measured at the thickest level of CFL.Results: The mean CFLT was 3.49±0.82 mm in the control group, and 4.82±0.76 mm in the AI group.The mean CFLCSA was 33.31±7.02 mm 2 in the control group, and 65.33±20.91 mm 2 in the AI group.The AI patients had significantly greater CFLT (P<0.001) and CFLCSA (P<0.001) than the control group participants. A receiver operating characteristic (ROC) curve analysis in the evaluation of the diagnostic tests showed that the optimal cut-off score of the CFLT was 4.06 mm, with 76.9% sensitivity, 76.0% specificity, and an area under the curve (AUC) of 0.89 (95% CI, 0.79-0.99). The optimal cut-off threshold of the CFLCSA was 43.85 mm 2 , with 92.3% sensitivity, 92.0% specificity, and AUC of 0.94 (95% CI, 0.86-1.00).Conclusions: Even though the CFLT and CFLCSA were both significantly associated with AI, the CFLCSA was a more sensitive diagnostic test.

“…Several studies have explored the possible correlation between ATFL structural changes and ankle joint stability. Some investigators (14) have found that injured ATFLs were longer and thicker than healthy ATFLs. Other researchers (16) have shown that chronic ankle sprain patients have a significantly greater ATFL area than control subjects.…”

Section: Introductionmentioning

confidence: 99%

“…To date, the vast majority of studies have focused on ATFL morphological changes (13)(14)(15)(16), including changes to ligament thickness, length, width, continuity, and crosssectional area. Several studies have explored the possible correlation between ATFL structural changes and ankle joint stability.…”

Section: Introductionmentioning

confidence: 99%

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?

Chen¹,

Wang²,

Liu³

et al. 2021

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.