Esparó Jordi, Vega Jordi, Cordier Guillaume, Johnson Rowena, Dallaudière Benjamin, Gasol-Santa Xavier, Dalmau-Pastor Miki
Osteosport Clinic, Manresa, Barcelona, Spain.
Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2024 Feb;32(2):352-360. doi: 10.1002/ksa.12052. Epub 2024 Jan 23.
Chronic pain can affect up to 40% of patients after ankle inversion sprains. The current hypothesis to explain this high percentage of chronic pain is a partial/total rupture of anterior talofibular ligament (ATFL) superior fascicle, a structure that has recently been described as intra-articular and as having a different function than ATFL's inferior fascicle. This has created the need for diagnosing ATFL superior and inferior fascicles independently. Therefore, the objective of this study is to investigate if the ATFL's superior fascicle can be visualized on ultrasound, and to describe its ultrasonographic appearance.
Twenty fresh-frozen ankle specimens were used in this 4-phases study. First, the specimens were scanned on US to identify what was believed to be ATFL's superior fascicle. Second, ATFL's superior fascicle was sutured under direct arthroscopic vision. Next, the specimens were scanned on US to obtain an image of the sutured structure. Finally, the specimens were dissected to confirm that the suture was indeed placed on ATFL's superior fascicle.
On the 20 specimens studied, full correlation was obtained between US, arthroscopic suture and specimen dissection. ATFL's superior fascicle US appearance is provided.
ATFL's superior fascicle can be visualized on US, which will allow to undergo diagnosis of isolated injuries to that fascicle, a common finding in ankle microinstability. The results of this study will facilitate the diagnosis of partial or complete rupture of ATFL's superior fascicle, likely increasing the amount of ankle microinstability diagnosis, impacting clinical management of ankle sprain consequences.
踝关节内翻扭伤后，慢性疼痛可能影响多达40%的患者。目前用于解释这种高比例慢性疼痛的假说是距腓前韧带（ATFL）上束部分/完全断裂，该结构最近被描述为关节内结构，其功能与ATFL下束不同。这就需要独立诊断ATFL上束和下束。因此，本研究的目的是调查ATFL上束是否能在超声下显影，并描述其超声表现。
本四阶段研究使用了20个新鲜冷冻的踝关节标本。首先，对标本进行超声扫描，以确定被认为是ATFL上束的结构。其次，在关节镜直视下缝合ATFL上束。接下来,对标本进行超声扫描，以获取缝合结构的图像。最后，解剖标本以确认缝线确实位于ATFL上束上。
在所研究的20个标本中，超声、关节镜缝合和标本解剖之间完全相关。提供了ATFL上束的超声表现。
ATFL上束可在超声下显影，这将有助于诊断该束的孤立损伤，这是踝关节微不稳定中的常见发现。本研究结果将有助于诊断ATFL上束的部分或完全断裂，可能增加踝关节微不稳定的诊断数量，影响踝关节扭伤后果的临床管理。
