Ultrasonography of the lateral ligament in ankle sprains
Author
Zadran, Spogmai
Term
5. Term (Master thesis)
Education
Publication year
2015
Pages
35
Abstract
Baggrund: Forstuvninger i anklens yderside udgør ca. 85% af alle forstuvninger. På længere sigt udvikler omkring 20% kronisk lateral ankelinstabilitet med vedvarende smerter, gentagne forstuvninger og en fornemmelse af, at anklen giver efter. Formål: At bruge ultralyd til at graduere ledbåndsskader efter en akut ankelforstuvning og at relatere fundene til patientrapporterede spørgeskemasvar over et år. Metode: Tværsnitsstudie fra 15. oktober til 26. november. 26 voksne (18–40 år) diagnosticeret i akutmodtagelsen blev undersøgt klinisk og fik dynamisk ultralyd af anklen inden for 15 dage. Højfrekvent ultralyd (6–15 MHz) vurderede ydre ledbånd (ATFL, CFL), syndesmosen mellem skinnebenene (AiTFL) og—ved kliniske tegn på indersideskade—udvalgte mediale ledbånd (dPT, TCt). Deltagerne blev fulgt med elektroniske patientrapporterede målinger via e-mail hver tredje måned i op til et år. Resultater: 16 kvinder og 10 mænd; gennemsnitsalder 26,7 år; gennemsnitligt BMI 26,6 (17,2–41,3). To kliniske tegn havde statistisk sammenhæng med ultralydsfund: ømhed ved palpation over AiTFL-området var forbundet med en partiel ruptur af ATFL; smerte under aktiv plantarfleksion var forbundet med intakt (normal) CFL. Samlet set var kliniske tegn og den fysiske undersøgelse upålidelige til at identificere laterale, syndesmotiske og mediale ledbåndsskader sammenlignet med ultralyd. Konklusion: Tidligt efter ankelforstuvning gav ultralyd mere pålidelige oplysninger om hvilke ledbånd der var skadet end klinisk undersøgelse alene. Enkelte kliniske tegn havde begrænset prædiktiv værdi, hvilket understreger ultralydens rolle i klassifikation af ledbåndsskader.
Background: Lateral ankle sprains account for about 85% of all sprains. In the longer term, roughly 20% develop chronic lateral ankle instability, with ongoing pain, repeated sprains, and episodes of the ankle giving way. Aim: To use ultrasound to grade ligament injuries after acute ankle sprain and to relate these findings to patient-reported questionnaires over one year. Methods: Cross-sectional study from October 15 to November 26. Twenty-six adults (18–40 years) diagnosed in an emergency department underwent a clinical exam and dynamic ultrasound within 15 days. High-frequency ultrasound (6–15 MHz) assessed lateral ligaments (anterior talofibular ligament, ATFL; calcaneofibular ligament, CFL), the syndesmosis between the tibia and fibula (anterior inferior tibiofibular ligament, AiTFL), and—when medial signs were present—selected medial ligaments (dPT, TCt). Participants received electronic patient-reported outcome questionnaires by email every three months for up to one year. Results: Sixteen women and ten men; mean age 26.7 years; mean BMI 26.6 (range 17.2–41.3). Two clinical signs showed statistically significant associations with ultrasound findings: tenderness on palpation over the AiTFL area was associated with a partial ATFL tear; pain during active plantarflexion was associated with an intact (normal) CFL. Overall, clinical signs and physical examination alone were unreliable for identifying lateral, syndesmotic, and medial ligament injuries compared with ultrasound. Conclusion: Early after ankle sprain, ultrasound provided more dependable information about which ligaments were injured than clinical examination alone. A few clinical signs had limited predictive value, underscoring the role of ultrasound in classifying ligament injury.
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