Diagnostic Value of Early Magnetic Resonance Imaging After Acute Lateral Ankle Injury

Miller, Jason R.; Dunn, Karl W.; Ciliberti, Louis J.; Eldridge, Stephanie; Reed, Lauren D.

doi:10.1053/j.jfas.2017.05.011

Cited by 13 publications

(9 citation statements)

References 19 publications

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“…Concomitant injuries commonly occur with an acute LAS, 84,310 with bone bruising on magnetic resonance imaging (MRI) being one of the most common findings. 54,216 The extent of ankle effusion present after injury may be associated with more severe associated injuries, 70 but does not necessarily indicate the presence or absence of a fracture.…”

Section: Pathoanatomical Features Update 2021mentioning

confidence: 99%

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

Martin¹,

Davenport²,

Fraser³

et al. 2021

Journal of Orthopaedic & Sports Physical Therapy

100

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B Clinicians should include patient age, body mass index, pain coping strategies, report of instability, history of previous sprain, ability to bear weight, pain with weight bearing, ankle dorsiflexion range of motion (ROM), medial jointline tenderness, balance, and ability to jump and land (as safely tolerated) in their initial assessment, because of their role in influencing the clinical course and estimation of time to accomplish the goals of an individual with an acute lateral ankle sprain (LAS). CLINICAL COURSE -CHRONIC ANKLE INSTABILITYC Clinicians may include previous treatment, number of sprains, pain level, and self-report of function in their evaluation, as well as an assessment of the sensorimotor movement systems of the foot, ankle, knee, and hip during dynamic postural control and functional movements, because of their role in influencing the clinical course and estimation of time to accomplish the goals of an individual with chronic ankle instability (CAI). DIAGNOSIS/CLASSIFICATION -ACUTE LATERAL ANKLE SPRAINB Clinicians should use special tests, including the reverse anterolateral drawer test and anterolateral talar palpation in addition to the traditional anterior drawer test, and a thorough history and physical examination to aid in the diagnosis of a LAS. DIAGNOSIS/CLASSIFICATION -CHRONIC ANKLE INSTABILITYB When determining whether an individual has CAI, clinicians should use a reliable and valid discriminative instrument, such as the Cumberland Ankle Instability Tool or the Identification of Functional Ankle Instability, as well as a battery of functional performance tests that have established validity to differentiate between healthy controls and individuals with CAI. EXAMINATION -OUTCOME MEASURESA Clinicians should use validated patient-reported outcome measures, such as the Patient-Reported Outcomes Measurement Information System physical function and pain interference scales, the Foot and Ankle Ability Measure, and the Lower Extremity Functional Scale, as part of a standard clinical examination. Clinicians should utilize these before and 1 or more times after the application of interventions intended to alleviate the impairments of body function and structure, activity limitations, and participation restrictions associated with an acute LAS or CAI.C Clinicians may use the Pain Self-Efficacy Questionnaire in the acute and postacute periods after a LAS to assess effective coping strategies for pain, and the 11-item Tampa Scale of Kinesiophobia and the Fear-Avoidance Beliefs Questionnaire to assess fear of movement and reinjury and fear-avoidance beliefs in those with CAI. EXAMINATION -PHYSICAL IMPAIRMENT MEASURESA Clinicians should assess and document ankle swelling, ROM, talar translation, talar inversion, and single-leg balance in patients with an acute LAS, postacute LAS, or CAI at baseline and 2 or more times over an episode of care. Clinicians should specifically include measures of dorsiflexion, using the weight-bearing lunge test, static single-limb balance on a firm surface with eyes...

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Section: Pathoanatomical Features Update 2021mentioning

confidence: 99%

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

Martin¹,

Davenport²,

Fraser³

et al. 2021

Journal of Orthopaedic & Sports Physical Therapy

100

View full text Add to dashboard Cite

show abstract

“…Although prior studies have highlighted the association between lateral ankle sprains and high ankle sprains, it is unclear whether the syndesmotic ligaments may ultimately play a role in stabilizing the lateral ankle. 7,23,29,37 This study demonstrates that isolated syndesmosis disruption does not result in lateral ankle instability under fluoroscopic evaluation. In contrast, lateral ankle can become unstable when the syndesmosis is injured along with ATFL disruption.…”

Section: Discussionmentioning

confidence: 64%

Fluoroscopic Evaluation of the Role of Syndesmotic Injury in Lateral Ankle Instability in a Cadaver Model

et al. 2022

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Background: There is a high prevalence of concomitant lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Therefore, the aim of this study was to fluoroscopically evaluate the role of the syndesmotic ligaments in stabilizing the lateral ankle. Methods: Twenty-four cadaveric specimens were divided into 3 groups and fluoroscopically evaluated for lateral ankle stability with all syndesmotic and ankle ligaments intact and then following serial differential ligamentous transection. Group 1: (1) anterior talofibular ligament (ATFL), (2) calcaneofibular ligament (CFL), and (3) posterior talofibular ligament (PTFL). Group 2: (1) anterior inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), (3) posterior inferior tibiofibular ligament (PITFL), (4) ATFL, (5) CFL, and (6) PTFL. Group 3: (1) AITFL, (2) ATFL, (3) CFL, (4) IOL, (5) PTFL, and (6) PITFL. At each transection state, 3 loading conditions were used: (1) anterior drawer test performed using 50 and 80 N of direct force, (2) talar tilt <1.7 Nm torque, and (2) lateral clear space (LCS) <1.7 Nm torque. These measurements were in turn compared with those of the stressed intact ligamentous state. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A P value <.05 was considered statistically significant. Results: The lateral ankle remained stable after transection of all syndesmotic ligaments (AITFL, IOL, PITFL). However, after additional transection of the ATFL, the lateral ankle became unstable in varus and anterior drawer testing conditions ( P values ranging from .036 to .012). Lateral ankle instability was also observed after transection of the ATFL and AITFL in varus and anterior drawer testing conditions ( P values ranging from .036 to .012). Subsequent transection of the CFL and PTFL worsened the lateral ankle instability. Conclusion: Our findings suggest that isolated syndesmosis disruption does not result in lateral ankle instability. However, the lateral ankle became unstable when the syndesmosis was injured along with ATFL disruption. Clinical Relevance: When combined with ATFL release, disruption of the syndesmosis appeared to destabilize the lateral ankle.

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“…Up to date, especially the differentiation between IIA and IIB injuries remains clinically challenging. Although MRI is considered the noninvasive gold standard, it remains a static examination, the visualization of the IOM at the level of the syndesmotic complex is limited, and its reported diagnostic accuracy varies ( 9 , 10 ). As a result, the MRI is limited in distinguishing Grade IIA from Grade IIB injuries.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis on the value of the external rotation stress test under fluoroscopy to detect syndesmotic injuries

Spindler¹,

Herterich²,

Holzapfel³

et al. 2022

EFORT Open Reviews

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Purpose The aim was to conduct a systematic literature review and meta-anaylsis to analyze the diagnostic accuracy of the external rotation stress test (ERST) for syndesmotic injuries. Methods The systematic review was conducted according to the PRISMA-P guidelines (Prospero ID: CRD42021282457). Four common databases were searched from inception to September 29, 2021. Eligible were any studies facilitating the ERST under fluoroscopy in a defined state of syndesmotic instability. Syndesmotic ligament-specific rupture must have been proven by MRI, arthroscopy, or controlled dissection (cadaver study). Two reviewers independently conducted each step of the systematic literature review. The risk of bias was assessed by the Quality Appraisal for Cadaveric Studies Score scale. The data analysis was performed qualitatively and quantitatively. Results Eight studies were eligible for a qualitative analysis, and six studies were eligible for a quantitative analysis. All studies included were cadaver studies. The qualitative analysis comprised 94 specimens and revealed considerable heterogeneity. Six studies allowed for a quantitative analysis of the tibiofibular clear space (TFCS) and five studies for the medial clear space (MCS) during the ERST. The quantitative analysis of the TFCS revealed no significant differences between intact and any stage of syndesmotic injury. The MCS was able to differentiate between intact and 2-ligament- (Z = 2.04, P = 0.02), 3-ligament- (Z = 3.2, P = 0.001), and 3-ligament + deltoid ruptures (Z = 3.35, P < 0.001). Conclusion The ERST is the only noninvasive test to assess syndesmotic instability and can be conducted bilaterally. The uninjured contralateral side can serve as a baseline reference. Based on the conducted quantitative analysis, the MCS seems to be able to differentiate between stable (intact/1-ligament) and unstable (2-ligament/3-ligament) lesions.

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Diagnostic Value of Early Magnetic Resonance Imaging After Acute Lateral Ankle Injury

Cited by 13 publications

References 19 publications

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

Fluoroscopic Evaluation of the Role of Syndesmotic Injury in Lateral Ankle Instability in a Cadaver Model

A systematic review and meta-analysis on the value of the external rotation stress test under fluoroscopy to detect syndesmotic injuries

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