George John, Jaafar Zulkarnain, Hairi Indar R, Hussein Kamarul H
University of Malaya Research Imaging Center, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia -
J Sports Med Phys Fitness. 2020 May;60(5):749-757. doi: 10.23736/S0022-4707.20.10050-1. Epub 2020 Mar 4.
The objectives of this study were to find correlation between the clinical and ultrasound grading in anterior talofibular ligament and calcaneofibular ligament tear, and to determine the sensitivity and specificity of the two stability tests among the athletes. Subsequently, we would like to propose a new grading criterion for an ultrasound examination.
Two blinded assessors examined thirty-five patients with a history of recent lateral ankle sprain. The first assessor performed physical examination on the injured ankle by using the anterior drawer test and talar tilt test, and the second assessor performed dynamic and static ultrasound assessment for anterior talofibular ligament and calcaneofibular ligament. The clinical laxity grading and sonographic extent of ligamentous injury was graded into a three-point scale.
There was a moderate positive correlation between clinical test and ultrasound grading of anterior talofibular ligament and calcaneofibular ligament with Spearman's correlation coefficient values of 0.58 and 0.66 respectively. Clinical grading of anterior drawer test had 59.1% sensitivity (95% CI: 0.36-0.79) while ultrasound grading had 100.0% specificity (95% CI: 0.75-1.00), with positive likelihood ratio of 0.77 and negative likelihood ratio of 0.44 in detecting a complete (grade 3) anterior talofibular ligament tear (P<0.05). Meanwhile, the clinical grading of talar tilt test had 54.5% sensitivity (95% CI: 0.23-0.83) and ultrasound grading had 100.0% specificity (95% CI: 0.85-1.00), with positive likelihood ratio of 1.0 and negative likelihood ratio of 0.45 in detecting a complete grade 3 calcaneofibular ligament tear (P<0.05).
The dynamic ultrasound is recommended to determine the actual degree of disruption of the ligament especially when clinical grading under-grades the degree of tear. Grade 2 tears can vary from 10% tear to 90% tear causing the clinical correlation to become less strong. We recommend a new classification for ultrasound grading of grade 2 tears, which could result in a stronger correlation between clinical and ultrasound grading.
本研究的目的是找出距腓前韧带和跟腓韧带撕裂的临床分级与超声分级之间的相关性，并确定这两种稳定性测试在运动员中的敏感性和特异性。随后，我们希望提出一种新的超声检查分级标准。
两名盲法评估者检查了35例近期有外侧踝关节扭伤史的患者。第一名评估者通过前抽屉试验和距骨倾斜试验对受伤踝关节进行体格检查，第二名评估者对距腓前韧带和跟腓韧带进行动态和静态超声评估。临床松弛度分级和韧带损伤的超声范围分为三分制。
距腓前韧带和跟腓韧带的临床检查与超声分级之间存在中度正相关，Spearman相关系数值分别为0.58和0.66。前抽屉试验的临床分级敏感性为59.1%（95%CI：0.36 - 0.79），而超声分级特异性为100.0%（95%CI：0.75 - 1.00），在检测距腓前韧带完全（3级）撕裂时，阳性似然比为0.77，阴性似然比为0.44（P<0.05）。同时，距骨倾斜试验的临床分级敏感性为54.5%（95%CI：0.23 - 0.83），超声分级特异性为100.0%（95%CI：0.85 - 1.00），在检测跟腓韧带完全3级撕裂时，阳性似然比为1.0，阴性似然比为0.45（P<0.05）。
建议采用动态超声来确定韧带实际的损伤程度，尤其是当临床分级低估撕裂程度时。2级撕裂范围可从10%撕裂到90%撕裂，导致临床相关性变弱。我们建议对2级撕裂的超声分级采用新的分类方法，这可能会使临床分级与超声分级之间的相关性更强。
