Clinical diagnosis, arthrography, stress examination and surgical findings after inversion trauma of the ankle

Hoogenband, C. R. van den; Moppes, F. I. van; Stapert, J. W. J. L.; Greep, J. M.

doi:10.1007/bf00389583

Cited by 19 publications

(21 citation statements)

References 3 publications

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“…Appendix 2 (available online) provides detailed information on study characteristics. Two studies were retrospective reviews, 8 , 26 the rest being diagnostic case-control, 23 clinical trials, 63 or prospective cohort studies (n = 10). 11 , 14 , 19 , 21 , 38 , 40 , 49 , 50 , 64 , 65 Studies included an aggregate of 2391 participants.…”

Section: Resultsmentioning

confidence: 99%

“…The uninterpretable results were because of either excessive pain or swelling. 49 , 50 , 63 , 65 We believe that counting these patients as injury positive reflects what would have been done in the clinical setting, since clinicians would intuitively raise their suspicion of ligamentous damage if the patient presented with excessive levels of the aforementioned clinical signs. We grouped intermediate findings 49 , 63 (ie, tests were the clinician could not decide whether the patient had enough laxity to be determined injured vs uninjured) as disease negative, since the positivity criteria for stress testing is the definitive presence of increased joint laxity.…”

Section: Methodsmentioning

confidence: 99%

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Diagnostic Accuracy of Clinical Tests Assessing Ligamentous Injury of the Talocrural and Subtalar Joints: A Systematic Review With Meta-Analysis

Netterström-Wedin

Matthews

Bleakley

2021

Sports Health: A Multidisciplinary Approach

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Context: Ankle sprains are the most common acute musculoskeletal injury. Clinical tests represent the first opportunity to assess the sprain’s severity, but no systematic review has compared these tests to contemporary reference standards. Objective: To determine the diagnostic accuracy of clinical tests assessing the talocrural and subtalar joint ligaments after ankle sprain. Data Sources: CINAHL, EMBASE, MEDLINE, hand-searching, and PubMed-related article searches (inception to November 18, 2020). Study Selection: Eligible diagnostic studies compared clinical examination (palpation, joint laxity) against imaging or surgery. Studies at a high risk of bias or with high concerns regarding applicability on Quality Assessment of Diagnostic Accuracy Studies-2 were excluded from the meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3a. Data Extraction: True-positive, false-negative, false-positive, and true-negative findings were extracted to calculate sensitivity, specificity, and likelihood ratios. If ordinal data were reported, these were extracted to calculate Cohen’s kappa. Results: A total of 14 studies met the inclusion criteria (6302 observations; 9 clinical tests). No test had both sensitivity and specificity exceeding 90%. Palpation of the anterior talofibular ligament is highly sensitive (sensitivity 95%-100%; specificity 0%-32%; min-max; n = 6) but less so for the calcaneofibular ligament (sensitivity 49%-100%; specificity 26%-79%; min-max; n = 6). Pooled data from 6 studies (885 observations) found a low sensitivity (54%; 95% CI 35%-71%) but high specificity (87%; 95% CI 63%-96%) for the anterior drawer test. Conclusion: The anterior talofibular ligament is best assessed using a cluster of palpation (rule out), and anterior drawer testing (rule in). The talar tilt test can rule in injury to the calcaneofibular ligament, but a sensitive clinical test for the ligament is lacking. It is unclear if ligamentous injury grading can be done beyond the binary (injured vs uninjured), and clinical tests of the subtalar joint ligaments are not well researched. The generalizability of our findings is limited by insufficient reporting on blinding and poor study quality. Registration: Prospero ID: CRD42020187848. Data Availability: Data are available in a public, open access repository on publication, including our RevMan file and the CSV file used for meta-analysis: http://doi.org/10.5f281/zenodo.4917138

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Tests Assessing Ligamentous Injury of the Talocrural and Subtalar Joints: A Systematic Review With Meta-Analysis

Netterström-Wedin

Matthews

Bleakley

2021

Sports Health: A Multidisciplinary Approach

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“…69–71 For the PTFL, sensitivity decreases to 75% for anatomical reasons. 44,70 Further arthrography is invasive and is not able to provide images of the ligament itself, but it is an indirect tool for the diagnosis of rupture.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

Polzer

Kanz²,

Prall³

et al. 2012

Orthop Rev

121

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Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. We systematically searched PubMed and the Cochrane Database for randomized controlled trials, meta-analyses, systematic reviews or, if applicable, observational studies and classified them according to their level of evidence. According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries. Taken these recommendations into account, we present an applicable and evidence-based, step by step, decision pathway for the diagnosis and treatment of acute ankle injuries, which can be implemented in any emergency department or doctor's practice. It provides quality assurance for the patient and promotes confidence in the attending physician.

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“…Activity of joint-stabilizing muscles may reduce displacement (false-negative results) and must be regarded in any stress testing, especially if an acute injury is evaluated. 23…”

Section: Discussionmentioning

confidence: 99%

Observer Reliability in Ankle and Calcaneocuboid Stress Radiography

et al. 2008

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Clinical diagnosis, arthrography, stress examination and surgical findings after inversion trauma of the ankle

Cited by 19 publications

References 3 publications

Diagnostic Accuracy of Clinical Tests Assessing Ligamentous Injury of the Talocrural and Subtalar Joints: A Systematic Review With Meta-Analysis

Diagnostic Accuracy of Clinical Tests Assessing Ligamentous Injury of the Talocrural and Subtalar Joints: A Systematic Review With Meta-Analysis

Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

Observer Reliability in Ankle and Calcaneocuboid Stress Radiography

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