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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2018

Open Access 01-12-2018 | Research article

Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis

Authors: Shengxuan Cao, Chen Wang, Xin Ma, Xu Wang, Jiazhang Huang, Chao Zhang

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

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Abstract

Background

Various 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.

Methods

Relative 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.

Results

Fifteen 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.

Conclusion

This 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.
Literature
1.
Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123–40.CrossRefPubMed
2.
Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73–94.CrossRefPubMed
3.
Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):2279–84.CrossRefPubMed
4.
Bonnel F, Toullec E, Mabit C, Tourne Y. Chronic ankle instability: biomechanics and pathomechanics of ligaments injury and associated lesions. Orthop Traumatol Surg Res. 2010;96(4):424–32.CrossRefPubMed
5.
Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364–75.PubMedPubMedCentral
6.
Delahunt E, Coughlan GF, Caulfield B, Nightingale EJ, Lin CWC, Hiller CE. Inclusion criteria when investigating insufficiencies in chronic ankle instability. Med Sci Sports Exerc. 2010;42(11):2106–21.CrossRefPubMed
7.
de Vries JS, Krips R, Sierevelt IN, Blankevoort L, van Dijk CN. Interventions for treating chronic ankle instability. Cochrane Database Syst Rev. 2011; 10(8):Cd004124.
8.
Mailuhu AKE, Oei EHG, van Putte-Katier N, van Ochten JM, Bindels PJE, Bierma-Zeinstra SMA, van Middelkoop M. Clinical and radiological predictors for persistent complaints five years after a lateral ankle sprain: a long-term follow-up study in primary care. J Sci Med Sport. 2017; 21(3):250–6.
9.
Pourkazemi F, Hiller CE, Raymond J, Nightingale EJ, Refshauge KM. Predictors of chronic ankle instability after an index lateral ankle sprain: a systematic review. J Sci Med Sport. 2014;17(6):568–73.CrossRefPubMed
10.
Vega J, Pena F, Golano P. Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1116–23.CrossRefPubMed
11.
Hubbard TJ, Hertel J, Olmsted-Kramer L, Denegar CR. Contributing factors to chronic ankle instability. Med Sci Sports Exerc. 2006;38(5):S86–7.CrossRef
12.
Kerr HL, Bayley E, Jackson R, Kothari P. The role of arthroscopy in the treatment of functional instability of the ankle. Foot Ankle Surg. 2013;19(4):273–5.CrossRefPubMed
13.
Rodriguez-Merchan EC. Chronic ankle instability: diagnosis and treatment. Arch Orthop Trauma Sur. 2012;132(2):211–9.CrossRef
14.
Meehan TM, Martinez-Salazar EL, Torriani M. Aftermath of ankle inversion injuries: spectrum of MR imaging findings. Magn Reson Imaging Clin N Am. 2017;25(1):45–61.CrossRefPubMed
15.
Hashimoto T, Inokuchi S, Kokubo T. Clinical study of chronic lateral ankle instability: injured ligaments compared with stress X-ray examination. J Orthop Sci. 2009;14(6):699–703.CrossRefPubMed
16.
Schneiders A, Karas S. The accuracy of clinical tests in diagnosing ankle ligament injury. Eur J Phys. 2016;18(4):245–53.
17.
Guillo S, Bauer T, Lee JW, Takao M, Kong SW, Stone JW, Mangone PG, Molloy A, Perera A, Pearce CJ, et al. Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. Orthop Traumat Surg Res. 2013;99(8 Suppl):S411–9.CrossRef
18.
Michels F, Pereira H, Calder J, Matricali G, Glazebrook M, Guillo S, Karlsson J, Acevedo J, Batista J, Bauer T, et al. Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert. Knee Surg Sports Traumatol Arthros. 2017. https://​doi.​org/​10.​1007/​s00167-017-4556-0.
19.
Kwon DG, Sung KH, Chung CY, Park MS, Kim TW, Lee SH, Lee KM. Associations between MRI findings and symptoms in patients with chronic ankle sprain. J Foot Ankle Surg. 2014;53(4):411–4.CrossRefPubMed
20.
Radwan A, Bakowski J, Dew S, Greenwald B, Hyde E, Webber N. Effectiveness of ultrasonography in diagnosing chronic lateral ankle instability: a systematic review. Int J Sports Phys Ther. 2016;11(2):164–74.PubMedPubMedCentral
21.
Jolman S, Robbins J, Lewis L, Wilkes M, Ryan P. Comparison of magnetic resonance imaging and stress radiographs in the evaluation of chronic lateral ankle instability. Foot Ankle Int. 2017;38(4):397–404.CrossRefPubMed
22.
Takao M, Uchio Y, Naito K, Fukazawa I, Ochi M. Arthroscopic assessment for intra-articular disorders in residual ankle disability after sprain. Am J Sports Med. 2005;33(5):686–92.CrossRefPubMed
23.
Jung HG, Kim NR, Kim TH, Eom JS, Lee DO. Magnetic resonance imaging and stress radiography in chronic lateral ankle instability. Foot Ankle Int. 2017;38(6):621–6.CrossRefPubMed
24.
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36.CrossRefPubMed
25.
Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. BMJ (Clinical research ed). 2004;329(7458):168–9.CrossRef
26.
Deeks JJ. Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ (Clinical research ed). 2001;323(7305):157–62.CrossRef
27.
Park HJ, Lee SY, Park NH, Kim E, Chung EC, Kook SH, Lee JW. Usefulness of the oblique coronal plane in ankle MRI of the calcaneofibular ligament. Clin Radiol. 2015;70(4):416–23.CrossRefPubMed
28.
Park HJ, Lee SY, Park NH, Rho MH, Chung EC, Park JH, Park SJ. Three-dimensional isotropic T2-weighted fast spin-echo (VISTA) ankle MRI versus two-dimensional fast spin-echo T2-weighted sequences for the evaluation of anterior talofibular ligament injury. Clin Radiol. 2016;71(4):349–55.CrossRefPubMed
29.
Park HJ, Lee SY, Choi YJ, Hong HP, Park SJ, Park JH, Kim E. 3D isotropic T2-weighted fast spin echo (VISTA) versus 2D T2-weighted fast spin echo in evaluation of the calcaneofibular ligament in the oblique coronal plane. Clin Radiol. 2017;72(2):176 e171–7.CrossRef
30.
Scranton PE, McDermott JE, Rogers JV. The relationship between chronic ankle instability and variations in mortise anatomy and impingement spurs. Foot Ankle Int. 2000;21(8):657–64.CrossRefPubMed
31.
O'Neill PJ, Van Aman SE, Guyton GP. Is MRI adequate to detect lesions in patients with ankle instability? Clin Orthop Relat Res. 2010;468(4):1115–9.CrossRefPubMed
32.
Park HJ, Cha SD, Kim HS, Chung ST, Park NH, Yoo JH, Park JH, Kim JH, Lee TW, Lee CH, et al. Reliability of MRI findings of peroneal tendinopathy in patients with lateral chronic ankle instability. Clin Orthop Surg. 2010;2(4):237–43.CrossRefPubMedPubMedCentral
33.
Chun KY, Choi YS, Lee SH, Kim JS, Young KW, Jeong MS, Kim DJ. Deltoid ligament and tibiofibular syndesmosis injury in chronic lateral ankle instability: magnetic resonance imaging evaluation at 3T and comparison with arthroscopy. Korean J Radiol. 2015;16(5):1096–103.CrossRefPubMedPubMedCentral
34.
Yi J, Cha JG, Lee YK, Lee BR, Jeon CH. MRI of the anterior talofibular ligament, talar cartilage and os subfibulare: comparison of isotropic resolution 3D and conventional 2D T2-weighted fast spin-echo sequences at 3.0 T. Skelet Radiol. 2016;45(7):899–908.CrossRef
35.
Cha SD, Kim HS, Chung ST, Yoo JH, Park JH, Kim JH, Hyung JW. Intra-articular lesions in chronic lateral ankle instability: comparison of arthroscopy with magnetic resonance imaging findings. Clin Orthop Surg. 2012;4(4):293–9.CrossRefPubMedPubMedCentral
36.
Chandnani VP, Harper MT, Ficke JR, Gagliardi JA, Rolling L, Christensen KP, Hansen MF. Chronic ankle instability: evaluation with MR arthrography, MR imaging, and stress radiography. Radiology. 1994;192(1):189–94.CrossRefPubMed
37.
Cheng Y, Cai Y, Wang Y. Value of ultrasonography for detecting chronic injury of the lateral ligaments of the ankle joint compared with ultrasonography findings. Br J Radiol. 2014;87(1033):20130406.CrossRefPubMed
38.
Cho JH, Lee DH, Song HK, Bang JY, Lee KT, Park YU. Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1022–8.CrossRefPubMed
39.
Chou MC, Yeh LR, Chen CK, Pan HB, Chou YJ, Liang HL. Comparison of plain MRI and MR arthrography in the evaluation of lateral ligamentous injury of the ankle joint. J Chin Med Assoc. 2006;69(1):26–31.CrossRefPubMed
40.
Hua Y, Yang Y, Chen S, Cai Y. Ultrasound examination for the diagnosis of chronic anterior talofibular ligament injury. Acta Radiol. 2012;53(10):1142–5.CrossRefPubMed
41.
Joshy S, Abdulkadir U, Chaganti S, Sullivan B, Hariharan K. Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle. Foot Ankle Surg. 2010;16(2):78–80.CrossRefPubMed
42.
Kim YS, Kim YB, Kim TG, Lee SW, Park SH, Lee HJ, Choi YJ, Koh YG. Reliability and validity of magnetic resonance imaging for the evaluation of the anterior talofibular ligament in patients undergoing ankle arthroscopy. Arthroscopy. 2015;31(8):1540–7.CrossRefPubMed
43.
Kumar V, Triantafyllopoulos I, Panagopoulos A, Fitzgerald S, Niekerk LV. Deficiencies of MRI in the diagnosis of chronic symptomatic lateral ankle ligament injuries. Foot Ankle Surg. 2007;13(4):171–6.CrossRef
44.
Lee MH, Cha JG, Lee YK, Choi GC, Paik SH, Lee HK, Park SJ, Kim HJ. The bright rim sign on MRI for anterior talofibular ligament injury with arthroscopic correlation. AJR Am J Roentgenol. 2012;198(4):885–90.CrossRefPubMed
45.
Oae K, Takao M, Uchio Y, Ochi M. Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging. Skelet Radiol. 2010;39(1):41–7.CrossRef
46.
Park HJ, Cha SD, Kim SS, Rho MH, Kwag HJ, Park NH, Lee SY. Accuracy of MRI findings in chronic lateral ankle ligament injury: comparison with surgical findings. Clin Radiol. 2012;67(4):313–8.CrossRefPubMed
47.
Staats K, Sabeti-Aschraf M, Apprich S, Platzgummer H, Puchner SE, Holinka J, Windhager R, Schuh R. Preoperative MRI is helpful but not sufficient to detect associated lesions in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc. 2017. https://​doi.​org/​10.​1007/​s00167-017-4567-x
48.
Sugimoto K, Takakura Y, Samoto N, Nakayama S, Tanaka Y. Subtalar arthrography in recurrent instability of the ankle. Clin Orthop Relat Res. 2002;394:169–76.CrossRef
49.
Tan DW, Teh DJW, Chee YH. Accuracy of magnetic resonance imaging in diagnosing lateral ankle ligament injuries: a comparative study with surgical findings and timings of scans. Asia Pac J Sport Med Arthrosc Rehabil Technol. 2017;7:15–20.
50.
Richardson ML. The Zombie plot: a simple graphic method for visualizing the efficacy of a diagnostic test. AJR Am J Roentgenol. 2016; 207(4):W43–W52.
51.
Liu K, Gustavsen G, Royer T, Wikstrom EA, Glutting J, Kaminski TW. Increased ligament thickness in previously sprained ankles as measured by musculoskeletal ultrasound. J Athl Train. 2015;50(2):193–8.CrossRefPubMedPubMedCentral
52.
Croy T, Saliba SA, Saliba E, Anderson MW, Hertel J. Differences in lateral ankle laxity measured via stress ultrasonography in individuals with chronic ankle instability, ankle sprain copers, and healthy individuals. J Orthop Sports Phys Ther. 2012;42(7):593–600.CrossRefPubMed
53.
Lee KT, Park YU, Jegal H, Park JW, Choi JP, Kim JS. New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound. Knee Surg Sports Traumatol Arthrosc. 2014;22(7):1701–7.CrossRefPubMed
54.
Martella I, Azzali E, Milanese G, Pratico FE, Ruggirello M, Trunfio V, Parziale R, Corrado M, Della Casa G, Capasso R, et al. MRI in acute ligamentous injuries of the ankle. Acta bio-medica : Atenei Parmensis. 2016;87(Suppl 3):13–9.
55.
van Putte-Katier N, van Ochten JM, van Middelkoop M, Bierma-Zeinstra SM, Oei EH. Magnetic resonance imaging abnormalities after lateral ankle trauma in injured and contralateral ankles. Eur J Radiol. 2015;84(12):2586–92.CrossRefPubMed
56.
Choi WJ, Lee JW, Han SH, Kim BS, Lee SK. Chronic lateral ankle instability: the effect of intra-articular lesions on clinical outcome. Am J Sports Med. 2008;36(11):2167–72.CrossRefPubMed
57.
Tao H, Hu Y, Qiao Y, Ma K, Yan X, Hua Y, Chen S. T2—mapping evaluation of early cartilage alteration of talus for chronic lateral ankle instability with isolated anterior talofibular ligament tear or combined with calcaneofibular ligament tear. J Magn Reson Imaging. 2017; 47(1):69–77.
58.
Tourne Y, Besse JL, Mabit C. Chronic ankle instability. Which tests to assess the lesions? Which therapeutic options? Orthop Traumatol, Surg Res. 2010;96(4):433–46.CrossRef
59.
60.
Frost SC, Amendola A. Is stress radiography necessary in the diagnosis of acute or chronic ankle instability? Clin J Sport Med. 1999;9(1):40–5.CrossRefPubMed
61.
McCaskie AW, Gale DW, Finlay D, Allen MJ. Chronic ankle instability: the value of talar tilt under general anaesthesia. Br J Sports Med. 1995;29(2):103–4.CrossRefPubMedPubMedCentral
62.
Jeong BO, Kim TY, Song WJ. Effect of preoperative stress radiographic findings on radiographic and clinical outcomes of the modified Brostrom procedure for chronic ankle instability. J Foot Ankle Surg. 2016;55(1):125–8.CrossRefPubMed
63.
Trnka HJ, Ivanic G, Trattnig S. Arthrography of the foot and ankle. Ankle and subtalar joint. Foot Ankle Clin. 2000;5(1):49–62. vi.PubMed
64.
Samoto N, Sugimoto K, Takaoka T, Fujita T, Kitada C, Takakura Y. Comparative results of conservative treatments for isolated anterior talofibular ligament (ATFL) injury and injury to both the ATFL and calcaneofibular ligament of the ankle as assessed by subtalar arthrography. J Orthop Sci. 2007;12(1):49–54.CrossRefPubMed
65.
Kopkow C, Freiberg A, Kirschner S, Seidler A, Schmitt J. Physical examination tests for the diagnosis of posterior cruciate ligament rupture: a systematic review. J Orthop Sports Phys Ther. 2013;43(11):804–13.CrossRefPubMed
Metadata
Title
Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis
Authors
Shengxuan Cao
Chen Wang
Xin Ma
Xu Wang
Jiazhang Huang
Chao Zhang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-018-0811-4

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