Chronic ankle instability: diagnosis and treatment

Rodríguez-Merchán, E. Carlos

doi:10.1007/s00402-011-1421-3

Cited by 45 publications

(45 citation statements)

References 54 publications

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“…The precise cause of these symptoms is still in debate and probably multifactorial [ 5 , 10 – 12 ]. But identifying chronic lateral ankle ligament injury is critical for locating primal symptoms, and thus, the decision making of surgical intervention [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis

Cao

Wang

et al. 2018

J Orthop Surg Res

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BackgroundVarious imaging techniques have been utilized for the diagnosis of chronic lateral ankle ligament injury. This systemic review will explore the effectiveness of different imaging techniques in diagnosing chronic lateral ankle ligament injury.MethodsRelative studies were retrieved after searching 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trails). Eligible studies were summarized. Data were extracted to calculate pooled sensitivity and specificity of magnetic resonance imaging (MRI), ultrasonography (US), stress radiography, and arthrography.ResultsFifteen studies met our inclusion and exclusion criteria. A total of 695 participants were included. The pooled sensitivities in diagnosing chronic ATFL injury were 0.83 [0.78, 0.87] for MRI, 0.99 [0.96, 1.00] for US, and 0.81 [0.68, 0.90] for stress radiography. The pooled specificities in diagnosing chronic ATFL injury were 0.79 [0.69, 0.87] for MRI, 0.91 [0.82, 0.97] for US, and 0.92 [0.79, 0.98] for stress radiography. The pooled sensitivities in diagnosing chronic CFL injury were 0.56 [0.46, 0.66] for MRI, 0.94 [0.85, 0.98] for US, and 0.90 [0.73, 0.98] for arthrography. The pooled specificities in diagnosing chronic CFL injury were 0.88 [0.82, 0.93] for MRI, 0.91 [0.80, 0.97] for US, and 0.90 [0.77, 0.97] for arthrography.ConclusionThis systematic review with meta-analysis investigated the accuracy of imaging for the diagnosis of chronic lateral ankle ligament injury. Ultrasound manifested high diagnostic accuracy in diagnosing chronic lateral ankle ligament injury. Clinicians should be aware of the limitations of MRI in detecting chronic CFL injuries.

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Section: Introductionmentioning

confidence: 99%

Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis

Cao

Wang

et al. 2018

J Orthop Surg Res

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“…In many cases, this is due to pathomechanical forces acting on the unstable ankle [18]. Peroneal tendon pathologies, concomitant ligamentous and syndesmotic injuries, anterolateral impingement or osteochondral lesions are the most common associated injuries [8, 23]. Although magnetic resonance imaging (MRI) represents a standard diagnostic procedure, information about reliability and validity remains inconclusive [4, 21, 27].…”

Section: Introductionmentioning

confidence: 99%

Preoperative MRI is helpful but not sufficient to detect associated lesions in patients with chronic ankle instability

Staats

Sabeti-Aschraf

Apprich

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim of this study was to determine the reliability and validity of preoperative magnetic resonance imaging (MRI) scans for the detection of additional pathologies in patients with chronic ankle instability (CAI) compared to arthroscopic findings.MethodsPreoperative MRI images of 30 patients were evaluated regarding articular and periarticular comorbidities and compared to intraoperative findings. The reliability of MRI was determined by calculating specificity, sensitivity, as well as positive and negative predictive values. The accuracy of the classification of cartilage lesions by Outerbridge and Berndt and Harty rating scales was determined by calculating the area under the receiver operating curve (AUC).ResultsIn total, 72 additional pathologies were found arthroscopically compared to 73 lesions gathered from MRI images. Sensitivity ranged from 89% for peroneal tendinopathy to 28% for additional ligamentous lesions. Specificity ranged from 100% for anterolateral impingement, loose bodies and peroneal tendinopathy to 38% for additional ligamentous lesions. For cartilage lesions, sensitivity was at 91% and specificity was at 55% for the Outerbridge grading scale. For the Berndt and Harty classification system, sensitivity was at 91% and specificity was at 28%. Correlation of additional pathologies ranged from weak (r s = 0.48; p = 0.02) to moderate results (r s = 0.67; p < 0.001).ConclusionCAI is associated with a high incidence of additional pathologies. In some cases, MRI delivers insufficient results, which may lead to misinterpretation of present comorbidities. MRI is a helpful tool for preoperative evaluation, but arthroscopy remains gold standard in the diagnosis of associated lesions in patients with CAI.Level of evidenceIII.

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“…Rodriguez-Merchan empfiehlt daher bei anhaltend symptomatischen Patienten mit einer chronischen Instabilität und unauffälligem MRT-Befund eine diagnostische Arthroskopie mit gegebenenfalls anschließender operativer Behandlung [3,15].…”

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Erratum zu: Das instabile Sprunggelenk

2015

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Chronic ankle instability: diagnosis and treatment

Abstract: Conservative treatment of patients with CAI must be the first-line therapy. Surgical treatment must be indicated only when conservative treatment fails.

Cited by 45 publications

References 54 publications

Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis

Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis

Preoperative MRI is helpful but not sufficient to detect associated lesions in patients with chronic ankle instability

Erratum zu: Das instabile Sprunggelenk

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