Diagnosis and Imaging of Ankle Instability

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

“…However, imaging studies that evaluate ligament integrity have questionable value in assessing acute ankle injury because treatment decisions and outcomes are not usually influenced by the results of these studies. 94 Stress radiography has long been used to diagnose mechanical instability of the lateral ligaments of the ankle, but the reliability of these measures has been questioned. 11 Radiographic measurements of anterior drawer and talar tilt tests show low sensitivity (50% and 36%, respectively) but high specificity (100%).…”

An accuracy evaluation of clinical, arthrometric, and stress-sonographic acute ankle instability examinations

“…According to Valderrabano et al, 85% of acute ankle sprain occurrences are caused by a supination trauma [7]. Additionally, in nearly 85% of sprains, the lateral ankle ligaments are affected [8,9]. Among these ligament injuries, the anterior talofibular ligament is the most affected [10], as it is injured in approximately 95% of ankle sprains [11].…”

“…Notably, this number drops to 15% after ligament suturing [17]. For both sutured and unsutured cases, however, there may be chronic ankle instability, impingement syndrome, or cartilage and talus osteochondral lesions with subsequent osteoarthritic joint degeneration [8,11]. Therefore, severe ankle injuries have to be treated properly to reduce long-term effect occurrences [2,5,7,18].…”

“…According to the Ottawa Ankle and Foot Rules, radiologic imaging is not necessary to rule out the fractures that are often accompanied by acute ankle sprains [2,14]. Griffith et al mentioned that the ankle instability diagnostic options might include peroneal tenography and ankle arthrography [8]. However, some authors regard direct ultrasound diagnoses as superior to other evaluation methods, but, MRI is also accepted as a satisfactory diagnostic method [11,19].…”

“…There is an apparent trend in the literature to discontinue the use of stress Xrays for acute ankle instability detection [3,8,10,13]. According to the Ottawa Ankle and Foot Rules, radiologic imaging is not necessary to rule out the fractures that are often accompanied by acute ankle sprains [2,14].…”