Kristen Karl-Heinz, Seilern Und Aspang Jesse, Wiedemann Johannes, Hartenbach Florian, Platzgummer Hannes
Sportklinik Wien, Werdertorgasse 14/8, A-1010, Vienna, Austria.
Department of Musculoskeletal Radiology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
J Exp Orthop. 2019 Jul 2;6(1):30. doi: 10.1186/s40634-019-0199-z.
The most common cause of ankle injury is the supination trauma, inflicting a partial or complete rupture of the anterior talofibular ligament (ATFL). Among conventional diagnostic tools and procedures of sports injuries, the method of stress-ultrasonography is reportedly a promising diagnostic tool for examining injuries of the lateral ligaments of the ankle. Preceding studies predominantly examined the comparability of stress-ultrasonography and other established diagnostic tools in terms of efficacy, viability and quality. The purpose of this study was to assess the reliability of stress-ultrasonography of the ATFL based on varying examiner experience and patient positioning.
Sixteen healthy subjects were examined by four examiners with differing levels of skill and experience in ultrasonography, ranging from laymen to specialist. Measurements were recorded and interrater correlation coefficient (ICC) was applied in four positions, including a neutral position (A), medial rotation (B), plantar flexion (C) and inversion of the foot (D).
The length of the ATFL was 14.958 ± 2.145 mm in position A, 15.886 ± 1.994 mm in position B, 16.270 ± 1.858 mm in position C and 15.170 ± 1.781 mm in position D. The average length change was 0.928 ± 0.804 mm (6.656 ± 6.299%) in position B, 1.313 ± 1.266 mm (9.746 ± 9.484%) in position C and 0.213 ± 1.807 mm (2.604 ± 12.308%) in position D. The correlation of the combined results of all four investigators was 0.333 for position A, 0.386 for position B, 0.320 for position C and 0.517 for position D. The highest ICC (0.811) was recorded between the orthopedic specialist and the radiology specialist. The lowest ICC (0.299) was recorded between the laymen and the radiology specialist.
The reliability of the ATFL examination seems to be exceedingly dependent on the examiner's experience and skill in ultrasonographic (US) diagnostic. Moreover, the inversion positioning of the foot, described by the European Society of Musculoskeletal Radiology (ESSR) yielded the highest measurement reliability.
踝关节损伤最常见的原因是旋后创伤，可导致距腓前韧带（ATFL）部分或完全断裂。在运动损伤的传统诊断工具和程序中，应力超声检查方法据报道是一种用于检查踝关节外侧韧带损伤的有前景的诊断工具。先前的研究主要从有效性、可行性和质量方面检验了应力超声检查与其他既定诊断工具的可比性。本研究的目的是基于不同的检查者经验和患者体位评估ATFL应力超声检查的可靠性。
16名健康受试者由4名在超声检查方面技能和经验水平不同的检查者进行检查，从外行到专家。记录测量值，并在四个体位应用组内相关系数（ICC），包括中立位（A）、内旋（B）、跖屈（C）和足内翻（D）。
ATFL长度在A位为14.958±2.145mm，B位为15.886±1.994mm，C位为16.270±1.858mm，D位为15.170±1.781mm。平均长度变化在B位为0.928±0.804mm（6.656±6.299%），C位为1.313±1.266mm（9.746±9.484%），D位为0.213±1.807mm（2.604±12.30）。所有四名研究者的综合结果的相关性在A位为0.333，B位为0.386，C位为0.320，D位为0.517。骨科专家和放射科专家之间记录的ICC最高（0.811）。外行和放射科专家之间记录的ICC最低（0.299）。
ATFL检查的可靠性似乎极度依赖于检查者在超声（US）诊断方面的经验和技能。此外，欧洲肌肉骨骼放射学会（ESSR）描述的足内翻体位产生了最高的测量可靠性。
