The accuracy of clinical tests in diagnosing ankle ligament injury

Schneiders, Anthony G.; Karas, Steve

doi:10.1080/21679169.2016.1213880

Cited by 13 publications

(16 citation statements)

References 48 publications

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“…Accurate diagnosis of chronic lateral ankle ligament injury is considered critical for surgical intervention of chronic ankle instability [ 13 ]. Imaging diagnosis is usually non-invasive and can be of value when physical tests are ambiguous [ 16 ]. Results for the four including imaging diagnostic techniques have been reported; however, the diagnostic accuracy of each imaging technique is variable in different studies, partly due to different reference standards applied [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The patients’ history and clinical tests are important in diagnosis. A meta-analysis discussed the accuracy of clinical tests in diagnosing ankle ligament injury and claimed that clinicians cannot rule out ligamentous injury when physical tests are negative, and additional imaging is warranted [ 16 ]. Imaging is a helpful diagnostic method according to consensus of experts [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

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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“…The patients’ history and clinical manual tests are important for the diagnosis of acute or chronic ATFL injury. However, a systemic review investigated the accuracy of clinical manual tests and suggested that ligament injury cannot be ruled out even when clinical manual tests are negative [3]. When the results of clinical tests are ambiguous, imaging techniques like magnetic resonance imaging (MRI), stress radiography, and ultrasonography could be helpful.…”

Section: Introductionmentioning

confidence: 99%

Reliability and validity of different ankle MRI scanning planes for the anterior talofibular ligament injury diagnosis: a cadaveric study

Cao

Wang

et al. 2019

J Orthop Surg Res

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Background The objective of the current study is to compare reliability, accuracy, sensitivity, and specificity in magnetic resonance imaging (MRI) evaluation of anterior talofibular ligament (ATFL) among the routine axial scanning plane, oblique axial-coronal scanning plane, and oblique axial-sagittal scanning plane. Methods Twenty cadaveric feet were studied. ATFL was exposed before scanning. Routine axial, oblique axial-coronal, and oblique axial-sagittal MRI scanning of 20 ATFL-intact cadaveric feet were acquired utilizing a 1.5-T MRI unit. The scans were repeated on the 20 cadaveric feet after the ATFL was artificially injured. In total, 120 sets of MR images were obtained and were randomly numbered. Three independent observers who were blinded to the experiment evaluated the images. Interobserver agreement, sensitivity, specificity, and accuracy were calculated and compared between different scanning planes utilizing the McNemar test. Results The interobserver agreement was fair to good (kappa, 0.55 to 0.65) in the routine axial plane, fair to good (kappa, 0.557 to 0.75) in the oblique axial-sagittal plane, and excellent (kappa, 0.85 to 0.95) in the oblique axial-coronal plane. The accuracy was significantly higher when utilizing oblique axial-coronal MRI scanning than routine axial MRI scanning (reader 1: p = .018; reader 2: p = .005). Conclusions The diagnostic accuracy of oblique axial-coronal plane MRI was higher than the routine axial plane concerning ATFL injury, and the interobserver agreement was excellent. The oblique axial-coronal plane could be added to the MRI scanning protocol during clinical practices to improve the diagnostic accuracy of ATFL injury.

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“…Recommendations for clinical examination of suspected lateral ligamentous injury continue to be underpinned by palpation and manual stress tests (eg, anterior drawer and talar tilt). 13 However, only 2 reviews 54 , 55 have systematically reported their diagnostic accuracy. The most recent review 54 included just 5 studies, with the majority limited to arthrographic (stress radiography) reference standards.…”

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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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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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The accuracy of clinical tests in diagnosing ankle ligament injury

Cited by 13 publications

References 48 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

Reliability and validity of different ankle MRI scanning planes for the anterior talofibular ligament injury diagnosis: a cadaveric study

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

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