To Investigate The Clinical Application Value Of Shear Wave Elastography In The Lateral Collateral Ligament In Patients With Chronic Ankle Instability

Objective :To investigate the application value of shear wave elastography in evaluating the hardness of anterior talofibular ligament(ATFL)in patients with chronic ankle instability.Methods:In this study,from November 2021 to November 2022,30 patients with chronic ankle instability who met the inclusion criteria were recruited from the Outpatient Center of the Department of Sports Medicine,the First Affiliated Hospital of Kunming Medical University as the chronic ankle instability(CAI)group and 60 healthy subjects were selected as the healthy group.Objective self-assessment was performed by all subjects using the Cumberland Ankle Instability Questionnaire(CAIT)score,American Foot and Ankle Scale(AOFAS)score,Faam-Ability to Daily Living(FAAM-ADL)score,Faam-Motor ability(FAAM-S)score,and Visual Pain Scale(VAS)score.The experimenter records the final evaluation results.Twenty subjects(10 males and 10 females)were randomly selected from the healthy group for the reliability test.Experienced test evaluators A and B used ultrasonic shear wave elastography(SWE)to quantitatively evaluate the shear wave velocity(SWV)of the subjects in the neutral and tense ATFL positions.A week later,test evaluator A repeated the measurements with the same subjects.Subsequently,the elastic modulus of bilateral ATFL of all subjects was quantitatively assessed by SWE,and the correlation analysis was conducted between the elastic modulus of affected ATFL of the CAI group and gender,age,BMI,CAIT,VAS,AOFAS,and FAAM scores.SWVS of ATFL between and within groups were compared.P < 0.05 was considered to be statistically significant.Results:1 There were no significant differences in gender,age,and BMI between the CAI group and the healthy group(P > 0.05).2 Intertester reliability and retest reliability for ATFL neutral and tension SWV measured by SWE were good to excellent: intertester reliability was good at ATFL neutral(ICC = 0.87)and retest reliability was excellent(ICC = 0.93);ATFL had good inter-test reliability(ICC = 0.89)and good retest reliability(ICC = 0.96)when ATFL was tense.3 There was statistical significance in SWV values of ATFL in the neutral position and nervous position between the CAI group and healthy group(P < 0.05),and SWV values of ATFL in the nervous position were significantly higher than those in the neutral position.4 There was no significant difference between age and BMI in SWV values of ATFL neutral and tense positions between the CAI group and healthy group(P >0.05).5 The scores of CAIT,FAAM,AOFAS,and VAS on the affected side of the ankle in the CAI group were significantly lower than those on the healthy side,with statistical significance(P < 0.05).6 ATFL tension position and neutral position SWV were positively correlated with pain intensity(r = 0.514,0.488,P = 0.004).There was a negative correlation between SWV at ATFL neutral and FAAM-ADL(r =-0.457,P = 0.011).There was no significant difference between SWV at the ATFL tension position and FAAM-S score,AOFAS score,and CAIT score on the affected side(P > 0.05).7 The SWV value of ATFL in the affected side of the CAI group was significantly higher than that in the healthy group at a neutral position and tension position,with statistical significance(P < 0.05).There was no statistical significance in SWV of ATFL on the healthy side of the CAI group compared with the healthy group in neutral and tense positions(P > 0.05).Conclusions:1 SWE has high inter-tester reliability and retest reliability when evaluating the elastic modulus of the neutral and tense positions of the anterior talofibular ligament in normal people.The shear wave velocity of anterior talofibular ligament in tension position was significantly higher than that in neutral position.It can be seen that SWE is a reliable advanced diagnostic tool for evaluating the elastic modulus of skeletal muscle.2 For patients with chronic ankle instability,SWV value of the anterior talofibular ligament on the affected side was significantly higher than that on the healthy side,and SWV value of the affected ligament was positively correlated with VAS score.Therefore,exploring the changes of elasticity in the pathological conditions of the anterior talofibular ligament can help us to have a more comprehensive understanding of the pathogenesis of chronic ankle instability.