Ultrasound shear wave elastography of the anterior talofibular and calcaneofibular ligaments in healthy subjects

Abstract

Aim of study: Most sprained lateral ankle ligaments heal uneventfully, but in some cases the ligament’s elastic function is not restored, leading to chronic ankle instability. Ultrasound shear wave elastography can be used to quantify the elasticity of musculoskeletal soft tissues; it may serve as a test of ankle ligament function during healing to potentially help differentiate normal from ineffective healing. The purpose of this study was to determine baseline shear wave velocity values for the lateral ankle ligaments in healthy male subjects, and to assess inter-observer reliability. Material and methods: Forty-six ankles in 23 healthy male subjects aged 20–40 years underwent shear wave elastography of the lateral ankle ligaments performed by two musculoskeletal radiologists. Each ligament was evaluated three times with the ankle relaxed by both examiners, and under stress by a single examiner. Mean shear wave velocity values were compared for each ligament by each examiner. Inter-observer agreement was evaluated. Results: The mean shear wave velocity at rest for the anterior talofibular ligament was 2.09 ± 0.3 (range 1.41–3.17); and for the calcaneofibular ligament 1.99 ± 0.36 (range 1.29–2.88). Good inter-observer agreement was found for the anterior talofibular ligament and calcaneofibular ligament shear wave velocity measurements with the ankle in resting position. There was a significant difference in mean shear wave velocities between rest and stressed conditions for both anterior talofibular ligament (2.09 m/s vs 3.21 m/s; p <0.001) and calcaneofibular ligament (1.99 m/s vs 3.42 m/s; p <0.0001). Conclusion: Shear wave elastography shows promise as a reproducible method to quantify ankle ligament stiffness. This study reveals that shear waves velocities of the normal lateral ankle ligaments increased with applied stress compared to the resting state.

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

“…In addition, many new US methods have been derived clinically. Ultrasonic shear wave elastography found that the shear wave velocity of normal lateral ankle ligament increased with the increase of applied force[ 30 ]. 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.…”

Imaging Modalities to Diagnose, Follow, and Assess Treatment of Chronic Ankle Instability

“…Color coded elastograms can identify the "stiffness" of a structure. Gimber et al 31 established normative data for ankle ligament stiffness that can potentially be used in the clinical setting for the evaluation of healing.…”

Computer-Aided Ankle Ligament Injury Diagnosis from Magnetic Resonance Images Using Machine Learning Techniques

“…Further, it can potentially produce false negatives for ligament lesions, which would occur if the ligament was subjected to a yo-yo effect [ 11 , 13 , 15 , 16 , 17 , 18 ]. While staying at rest, it would exhibit a normal morphological structure, but leads to increased fiber elasticity, caused by a bad local collagen quality or quantity [ 19 ]. The prediction on the dynamic behavior of the ligament is possible even in a static exam such as MRI since this exam generates a good definition of the ultrastructure of tissues [ 1 , 17 , 20 , 21 ].…”