Guillodo Yannick, Varache Sophie, Saraux Alain
Unit of Rheumatology, Hôpital Cavale Blanche, Brest, France.
Foot Ankle Spec. 2010 Dec;3(6):331-4. doi: 10.1177/1938640010378531. Epub 2010 Sep 3.
Ankle sprains may be followed by chronic pain and/or instability, which may induce substantial disability, most notably in athletes. Chronic ankle instability promotes the development of cartilage lesions in athletes. Therefore, accurate evaluation of the ankle ligaments is crucial to the optimal management of chronic ankle instability after a sprain. The objective of this study was to assess the performance of ultrasonography in assessing damage to the anterior talofibular ligament (ATFL) in athletes with chronic ankle instability after a sprain. Consecutive patients seen at the author's clinic for ankle instability more than 3 months after a sprain underwent ultrasonography and computed arthrotomography after a clinical anterior drawer stress test. Cohen's kappa was computed to evaluate agreement between the 2 imaging modalities. This study included 56 patients, 46 men and 10 women, aged 15 to 69 years (mean, 30.1 ± 10.6 years). Mean time from the sprain to imaging was 7.6 ± 4.02 months. ATFL damage was found by ultrasonography in 34 (61%) of 56 patients and by computed arthrotomography in 39 of 55 patients (71%; κ = 0.76). Cartilage damage was visualized by computed arthrotomography in 14 (25%) patients, all of whom had ATFL damage. Agreement was substantial (κ = 0.76) between ultrasonography and computed arthrotomography for assessing the ATFL. The data support the use of ultra-sonography as the second-line investigation after a standard radiographic assessment in athletes with chronic ankle instability after a sprain.
踝关节扭伤后可能会出现慢性疼痛和/或不稳定，这可能导致严重残疾，在运动员中尤为明显。慢性踝关节不稳定会促使运动员出现软骨损伤。因此，准确评估踝关节韧带对于扭伤后慢性踝关节不稳定的最佳治疗至关重要。本研究的目的是评估超声检查在评估扭伤后患有慢性踝关节不稳定的运动员距腓前韧带（ATFL）损伤中的性能。在作者诊所就诊的连续患者，在扭伤后3个月以上出现踝关节不稳定，在进行临床前抽屉应力试验后接受了超声检查和计算机关节断层扫描。计算科恩kappa系数以评估两种成像方式之间的一致性。本研究纳入了56例患者，其中46例男性和10例女性，年龄在15至69岁之间（平均30.1±10.6岁）。从扭伤到成像的平均时间为7.6±4.02个月。56例患者中有34例（61%）通过超声检查发现ATFL损伤，55例患者中有39例（71%）通过计算机关节断层扫描发现ATFL损伤（κ=0.76）。14例（25%）患者通过计算机关节断层扫描发现软骨损伤，所有这些患者均有ATFL损伤。超声检查和计算机关节断层扫描在评估ATFL方面的一致性很高（κ=0.76）。这些数据支持在扭伤后患有慢性踝关节不稳定的运动员中，在标准X线评估后将超声检查作为二线检查方法。
