Assistant Professor of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Assistant Professor of Radiology, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
J Foot Ankle Surg. 2022 Mar-Apr;61(2):305-309. doi: 10.1053/j.jfas.2021.08.008. Epub 2021 Aug 20.
The present study aimed to evaluate the sensitivity and specificity of clinical tests and ultrasonography in detecting ankle ligament injuries. In this cross-sectional study, 105 patients with a history of ankle sprain were included. Ankle ligaments, including syndesmosis of ankle, as well as deltoid, calcaneofibular, anterior talofibular, and posterior talofibular ligaments were evaluated by clinical tests, ultrasonography, and magnetic resonance imaging. The sensitivity and specificity of ultrasound and clinical tests were assessed in normal, sprain, partial tear, and complete tear groups. The inter-observer reliability (Cohen's Kappa score) of the evaluated techniques with magnetic resonance imaging was assessed. Anterior drawer test showed a sensitivity and specificity of 81 and 80% in the detection of anterior talofibular ligament injuries, respectively. Ultrasonography showed 100% sensitivity and specificity in distinguishing normal anterior talofibular ligament from the torn or sprained ligament with a kappa value of 1. The sensitivity of ultrasonography in detecting normal calcaneofibular ligament and deltoid ligament was 93% and 90%, respectively. Ultrasonography was highly specific in detecting calcaneofibular ligament tear but it was not sensitive in this regard. Ultrasonography was proved reliable in determining the normal anterior talofibular ligament and calcaneofibular ligament from the torn or sprained ligament. Ultrasonography is an effective complementary tool for primary evaluation of ankle injuries, which leads to early diagnosis and efficient quality of care. Clinical tests are not reliable to rule out the ankle ligaments injury and the results should be interpreted with caution.
本研究旨在评估临床检查和超声检查在检测踝关节韧带损伤中的敏感性和特异性。在这项横断面研究中，纳入了 105 例有踝关节扭伤史的患者。采用临床检查、超声和磁共振成像对踝关节包括踝关节联合、距腓前韧带、跟腓韧带、距腓后韧带和三角韧带进行评估。评估了超声和临床检查在正常、扭伤、部分撕裂和完全撕裂组中的敏感性和特异性。评估技术与磁共振成像的观察者间可靠性（Cohen's Kappa 评分）。前抽屉试验在检测距腓前韧带损伤时的敏感性和特异性分别为 81%和 80%。超声检查在鉴别正常距腓前韧带与撕裂或扭伤的距腓前韧带方面具有 100%的敏感性和特异性，kappa 值为 1。超声检查在检测正常跟腓韧带和三角韧带的敏感性分别为 93%和 90%。超声检查在检测跟腓韧带撕裂时具有高度特异性，但在这方面不敏感。超声检查在确定正常距腓前韧带和跟腓韧带与撕裂或扭伤的韧带方面是可靠的。超声检查是踝关节损伤初步评估的有效辅助工具，可早期诊断并提高护理质量。临床检查不能可靠地排除踝关节韧带损伤，结果应谨慎解释。
