Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan.
Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan.
J Orthop Sci. 2024 Nov;29(6):1438-1444. doi: 10.1016/j.jos.2023.11.006. Epub 2023 Nov 22.
In quantitative ankle stress sonography, different examiners use different techniques, which may cause measurement variability. This study aimed to clarify whether standardizing stress sonography techniques reduces variability in the quantitative measurement of anterior talofibular ligament length change.
Fourteen examiners with a mean ultrasound experience of 8.7 years participated in this study. Each examiner performed stress ultrasonography of the ankle using their preferred method on one patient with an intact anterior talofibular ligament (Patient 1) and on two patients with chronic ankle instability (Patient 2 and 3). Changes in the ligament length between the resting and stressed positions were determined. A consensus meeting was then conducted to standardize the sonographic technique, which was used by the examiners during a repeat stress sonography on the same patients. The variance and measured values were compared between the preferred and standardized techniques using F-tests and paired t-tests, respectively.
At a consensus meeting, a sonographic technique in which the examiner pushed the lower leg posteriorly against the fixed foot was adopted as the standardized technique. In Patient 1, the change in the anterior talofibular ligament length was 0.4 (range, -2.3-1.3) mm and 0.6 (-0.6-1.7) mm using the preferred and standardized techniques, respectively, with no significant difference in the variance (P = 0.51) or the measured value (P = 0.52). The length changes in Patient 2 were 2.0 (0.3-4.4) mm and 1.7 (-0.9-3.8) mm using the preferred and standardized techniques, respectively. In Patient 3, the length changes were 1.4 (-2.7-7.1) mm and 0.7 (-2.0-2.3) mm. There were no significant differences between the techniques in either patient group.
Variability in the quantitative measurement of ankle stress sonography was not reduced despite the standardization of the technique among examiners. Hence, comparing the measured values between different examiners should be avoided.
在定量踝关节应力超声检查中，不同的检查者使用不同的技术，这可能导致测量的变异性。本研究旨在阐明标准化超声检查技术是否会降低前距腓韧带长度变化的定量测量的变异性。
14 名检查者平均超声检查经验为 8.7 年，他们使用各自偏爱的方法对 1 名前距腓韧带完整的患者（患者 1）和 2 名慢性踝关节不稳定患者（患者 2 和 3）进行了踝关节应力超声检查。确定韧带在休息和受力位置之间的长度变化。然后进行了一次共识会议，以标准化超声技术，检查者在对同一患者进行重复的应力超声检查时使用该技术。使用 F 检验和配对 t 检验分别比较了首选技术和标准化技术的方差和测量值。
在共识会议上，采用了一种检查者将小腿向后推抵固定足部的超声技术作为标准化技术。在患者 1 中，使用首选技术和标准化技术测量的前距腓韧带长度变化分别为 0.4（范围，-2.3 至 1.3）mm 和 0.6（-0.6 至 1.7）mm，方差无显著差异（P=0.51）或测量值（P=0.52）。在患者 2 中，使用首选技术和标准化技术测量的长度变化分别为 2.0（0.3 至 4.4）mm 和 1.7（-0.9 至 3.8）mm。在患者 3 中，长度变化分别为 1.4（-2.7 至 7.1）mm 和 0.7（-2.0 至 2.3）mm。在两个患者组中，技术之间均无显著差异。
尽管在检查者之间标准化了技术，但踝关节应力超声检查的定量测量的变异性并未降低。因此，应避免比较不同检查者的测量值。
