Cho Jae Ho, Lee Doo Hyung, Song Hyung Keun, Bang Joon Young, Lee Kyung Tai, Park Young Uk
Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
Foot and Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1022-8. doi: 10.1007/s00167-015-3828-9. Epub 2015 Oct 29.
Clinicians frequently diagnose chronic ankle instability using the manual anterior drawer test and stress radiography. However, both examinations can yield incorrect results and do not reveal the extent of ankle instability. Stress ultrasound has been reported to be a new diagnostic tool for the diagnosis of chronic ankle instability. The purpose of this study was to assess the diagnostic value of stress ultrasound for chronic ankle instability compared to the manual anterior drawer test, stress radiography, magnetic resonance imaging (MRI), and arthroscopy.
Twenty-eight consecutive patients who underwent ankle arthroscopy and subsequent modified Broström repair for treatment of chronic ankle instability were included. The arthroscopic findings were used as the reference standard. A standardized physical examination (manual anterior drawer test), stress radiography, MRI, and stress ultrasound were performed to assess the anterior talofibular ligament (ATFL) prior to operation. Ultrasound images were taken in the resting position and the maximal anterior drawer position.
Grade 3 lateral instability was verified arthroscopically in all 28 cases with a clinical diagnosis (100%). Twenty-two cases showed grade III instability on the manual anterior drawer test (78.6%). Twenty-four cases displayed anterior translation exceeding 5 mm on stress radiography (86%), and talar tilt angle exceeded 15° in three cases (11 %). Nineteen cases displayed a partial chronic tear (change in thickness or signal intensity), and nine cases displayed complete tear on MRI (100%). Lax and wavy ATFL was evident on stress ultrasound in all cases (100 %). The mean value of the ATFL length was 2.8 ± 0.3 cm for the stressed condition and 2.1 ± 0.2 cm for the resting condition (p < 0.001).
Stress ultrasound may be useful for the diagnosis of chronic ankle instability in addition to the manual anterior drawer test and stress radiography.
III.
临床医生常通过手法前抽屉试验和应力位X线片诊断慢性踝关节不稳。然而，这两种检查都可能得出错误结果，且无法揭示踝关节不稳的程度。据报道，应力超声是诊断慢性踝关节不稳的一种新的诊断工具。本研究的目的是评估应力超声相对于手法前抽屉试验、应力位X线片、磁共振成像（MRI）和关节镜检查在诊断慢性踝关节不稳方面的诊断价值。
纳入28例连续接受踝关节镜检查及随后改良Broström修复术治疗慢性踝关节不稳的患者。关节镜检查结果用作参考标准。术前进行标准化体格检查（手法前抽屉试验）、应力位X线片、MRI和应力超声检查，以评估距腓前韧带（ATFL）。在静止位和最大前抽屉位拍摄超声图像。
所有28例临床诊断为慢性踝关节不稳的患者经关节镜检查均证实为3级外侧不稳（100%）。22例手法前抽屉试验显示为III级不稳（78.6%）。24例应力位X线片显示前移位超过5 mm（86%），3例距骨倾斜角超过15°（11%）。19例MRI显示部分慢性撕裂（厚度或信号强度改变），9例显示完全撕裂（100%）。所有病例应力超声均显示ATFL松弛且呈波浪状（100%）。应力状态下ATFL长度的平均值为2.8±0.3 cm，静止状态下为2.1±0.2 cm（p<0.001）。
除手法前抽屉试验和应力位X线片外，应力超声可能有助于诊断慢性踝关节不稳。
III级。
