The correlation between clinical and ultrasound evaluation of anterior talofibular ligament and calcaneofibular ligament tears in athletes

George, John; Jaafar, Zulkarnain; Hairi, Indar R; Hussein, Kamarul Hashimy

doi:10.23736/s0022-4707.20.10050-1

Cited by 8 publications

(45 citation statements)

References 28 publications

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“…11 In addition to the binary classification of injury status, 2 of the 14 studies also assessed the level of agreement for ordinal injury grading between index and reference testing. 8,21 The reference standards used were arthrography 19,49,50,[63][64][65] (n = 6), arthroscopy or surgery 8,41 (n = 2), MRI 14,23 (n = 2), and ultrasound 11,21,26,38 (n = 4). Two of the 6 studies using arthrography as the reference standard did not aim to differentiate between the affected ligaments during reference testing, counting any ligament sprain as a positive finding.…”

Section: Study Characteristics and Resultsmentioning

confidence: 99%

“…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. The proportion of women within each study ranged from 23% to 51%.…”

Section: Resultsmentioning

confidence: 99%

“… 8 , 11 , 14 , 20 , 23 , 26 , 38 Eleven of 14 studies included sporting populations. 11 , 19 , 21 , 23 , 26 , 38 , 40 , 49 , 50 , 63 , 64 Only Gremeaux et al 26 and van der Ent 64 specified the level of play, the majority of which were recreational practitioners (85%) and amateur competitors (46%), respectively. Most studies included participants with recent (≤7 days) ankle injuries, 14 , 19 , 26 , 40 , 49 , 50 , 63 - 65 with the remainder enrolling participants with either chronic ankle instability, 8 , 23 , 38 or a mixture of both.…”

Section: Resultsmentioning

confidence: 99%

“…George et al 21 used a similar clinical grading scale (no/some/ gross laxity; grade 1/2/3) and cross-referenced the findings with…”

Section: Assessing the Degree Of Ligamentous Injurymentioning

confidence: 99%

“…George et al 21 George et al 21 also examined agreement between clinical grading during the talar tilt test and the degree of CFL rupture during dynamic ultrasonography. The proportion of unaffected ankles were greater (15 vs 8) for the CFL in comparison to the ATFL, and tears were evenly distributed between partial (n 5), and total (n = 5) ruptures.…”

Section: Assessing the Degree Of Ligamentous Injurymentioning

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: Study Characteristics and Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…George et al 21 used a similar clinical grading scale (no/some/ gross laxity; grade 1/2/3) and cross-referenced the findings with…”

Section: Assessing the Degree Of Ligamentous Injurymentioning

confidence: 99%

Section: Assessing the Degree Of Ligamentous Injurymentioning

confidence: 99%

See 3 more Smart Citations

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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Chronic ankle instability has no correlation with the number of ruptured ligaments in severe anterolateral sprain: a systematic review and meta-analysis

Pacheco¹,

Guerra-Pinto

Araújo³

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Despite being a signiicant public health problem, ankle sprains' prognostic factors are largely unknown. This review aimed to systematically analyze the literature on acute ankle sprains to compare the prognosis of a combined anterior taloibular (ATFL) and calcaneoibular (CFL) ligaments rupture with an isolated ATFL rupture in terms of progression to chronic ankle instability and other clinical outcomes. Methods The databases for Pubmed, CENTRAL and Web of Science were searched. Clinical studies reporting the prognostic efect of combined ATFL-CFL rupture versus an isolated ATFL rupture in conservatively treated ankle sprains, with a minimum follow-up of 12 months, were eligible for inclusion. Only studies with a reliable diagnostic method for anterolateral ankle ligaments evaluation, namely ultrasonography, magnetic resonance imaging, arthrography or stress tenography, were included. The relative risk (RR), along with the 95% conidence interval (CI), was used to quantitatively analyze the main outcomes. Results Nine papers were selected for inclusion, of which ive were suitable for quantitative analysis. None of them found a statistically signiicant correlation between ligament injury severity and progression to chronic instability. Concerning other clinical outcomes, three studies found a statistically signiicant correlation between a combined ligament injury and a worse clinical prognosis. From the quantitative analysis, the relative risk (RR) of chronic ankle instability in a single versus a combined ligament rupture showed no signiicant diference. Conclusion A signiicant statistical correlation between a combined ATFL-CFL rupture and chronic ankle instability, compared to an isolated ATFL rupture, was not found. There is, however, fair evidence showing a worse clinical outcome score in the combined ruptures, as well as a decreased return to full sports activities. The use of reliable and accessible diagnostic methods to determine the number of ruptured ligaments might have a role in managing severe ankle sprains. Level of evidence Level III.

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Recent advances in the management of chronic ankle instability

Yang,

Wu,

Zhu

2024

Chinese Journal of Traumatology

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The correlation between clinical and ultrasound evaluation of anterior talofibular ligament and calcaneofibular ligament tears in athletes

Cited by 8 publications

References 28 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

Chronic ankle instability has no correlation with the number of ruptured ligaments in severe anterolateral sprain: a systematic review and meta-analysis

Recent advances in the management of chronic ankle instability

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