Colò Gabriele, Bignotti Bianca, Costa Giacomo, Signori Alessio, Tagliafico Alberto Stefano
Orthopedic Section, National Hospital of SS. Antonio and Biagio and C. Arrigo, 15121 Alessandria, Italy.
Department of Radiology, IRCCS-Ospedale Policlinico San Martino, 16132 Genova, Italy.
Diagnostics (Basel). 2023 Jul 10;13(14):2324. doi: 10.3390/diagnostics13142324.
Ankle sprains represent the second most common cause of emergency department access for musculoskeletal injury and lateral ankle ligament complex tears account for 850,000 cases annually in the United States with a relapse rate of 70%. Clinical examination is limited due to its subjectivity and the difficulty of identifying a specific involvement of the ligament; therefore, US and MRI are frequently requested. Therefore, the goal of this study is to analyze the available literature on the use of ultrasound (US) and magnetic resonance imaging (MRI) to diagnose injuries to the anterior talofibular ligament (ATFL) with a meta-analytic approach.
According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, all studies regarding the diagnostic accuracy of ultrasound and magnetic resonance imaging ATFL injuries were searched and assessed. The data were obtained from two independent reviewers with 12 and 3 years of experience in meta-analysis. A QUADAS-2 (Quality Assessment of Studies of Diagnostic Accuracy Studies) checklist was carried out to assess the risk of biases. From the selected studies, the sensitivity, specificity, and accuracy data were extracted.
Nine studies were included. The results of the meta-analysis demonstrate a greater sensitivity for ultrasound [96.88 (95% CI: 94-99) (fixed effects); 97 (95% CI: 94-99) (random effects)] compared to MRI [88.50 (95% CI: 85-91) (fixed effects); 86.98 (95% CI: 77-94) (random effects)], < 0.05. The result of this meta-analysis shows that the less expensive diagnostic technique is also the most sensitive for the diagnosis of ATFL tears. Ultrasound articles resulted to have non-heterogeneity [( = 0.2816; I° = 21.4607%)].
This meta-analysis demonstrates that US appears to be a highly sensitive diagnostic technique for diagnosing tears of the ATFL. Compared to MRI, the sensitivity of US result was higher.
踝关节扭伤是肌肉骨骼损伤患者前往急诊科就诊的第二大常见原因，在美国，每年有85万例踝关节外侧韧带复合体撕裂病例，复发率为70%。由于临床检查具有主观性且难以确定韧带的具体损伤情况，其应用受到限制；因此，超声和磁共振成像检查的需求较为频繁。因此，本研究的目的是采用荟萃分析方法，分析关于使用超声（US）和磁共振成像（MRI）诊断距腓前韧带（ATFL）损伤的现有文献。
根据PRISMA（系统评价和荟萃分析优先报告项目）指南，检索并评估所有关于超声和磁共振成像诊断ATFL损伤准确性的研究。数据由两位分别具有12年和3年荟萃分析经验的独立评审员获取。采用QUADAS - 2（诊断准确性研究的质量评估）清单评估偏倚风险。从所选研究中提取敏感性、特异性和准确性数据。
纳入9项研究。荟萃分析结果显示，与MRI相比，超声的敏感性更高[96.88（95%可信区间：94 - 99）（固定效应）；97（95%可信区间：94 - 99）（随机效应）]，而MRI的敏感性为[88.50（95%可信区间：85 - 91）（固定效应）；86.98（95%可信区间：77 - 94）（随机效应）]，P < 0.05）。该荟萃分析结果表明，成本较低的诊断技术对ATFL撕裂的诊断也最敏感。超声相关文章显示不存在异质性（Q = 0.2816；I² = 21.4607%）。
该荟萃分析表明，超声似乎是诊断ATFL撕裂的一种高度敏感的诊断技术。与MRI相比，超声的敏感性更高。
