High-resolution Ultrasonic Diagnosis In Ankle Injury

OBJECTIVE:The purpose of this study was to assess the accuracy of ultrasonography (US) in the diagnosis of anterior talofibular ligament (ATFL) injuries.Materials and methods:Between January2010and November2012,580patients with a clinical suspicion of lateral ankle ligament injuries referred to an orthopedic clinic of a tertiary referral hospital after sprain, were taken US examination of the lateral ankle. Among these patients,122cases including87males and35females, with a mean age of32years (range,15-70years), who were performed operation were recruited. The duration of symptoms ranged from4weeks to20years (mean2.2years). The results of ultrasound were not used as a diagnostic criterion which means diagnosis was based on the medical history, the physical examination and stress radiology or MRI. Patients with other combined disease, such as rheumatoid disease, were excluded from the study. Most of the operations were performed as soon as possible after US, with a mean US to surgery interval of4days (1-7days).Real-time ultrasound scanning was performed with an IU-22US unit (Philips Medical Systems, Bothell, WA, USA). A wide frequency linear array transducer (5-17MHz) was used. The ultrasound examiner was blind to the diagnosis and the other examination results of patients. During the examination, subjects were in a supine position with the ankle passively placed in a maximal inversion and plantar flexion position. Axial and transversal sonography of the ATFL was both obtained around the tip of the lateral malleolus. Particular attention was paid to keep the ultrasound beam perpendicular to the ligament to avoid artifact. Bilateral examination was performed if required. The following conditions of sonogram were seen:(1)normal:there is no abnormal finding;(2) stretching of ligament:loss of tension of the ligament;(3) enlargement of the ligament:the width of the ligament was2.4mm or20%of the contralateral normal ligament;(4)ligament tear:hypoechoic lesion within the ligament or ligament stump with posterior acoustic shadowing;(5) ligament absorbed:no ligament fibers were seen;(6) bony avulsions: osseous formation within the ligament or irregularities of the fibular end and the tip of the lateral malleolus.Operation was performed by an experienced sports medicine surgeon who was blind to the ultrasonograghy results.79patients underwent ankle arthroscopy and43patients had open surgery. In the operations, the contour of ligament was examined and the injury was clarified. The surgical findings of ATFL were classified into the same types as US classification. Except type1, the other findings, such as laxity or the tear of the ligament, obvious swollen ligament, absence of ligament or an avulsion fracture, were defined as ATFL injuries.US results were compared with surgical findings, which were used as the standard of reference. The sensitivities, specificities, accuracies, negative and positive predictive values, and positive and negative likelihood ratios were calculated using the statistical software program SPSS (version16.0, SPSS, Chicago, IL, USA).Result:The results of ultrasound examination and operation corresponded in113of122cases, which gives an accuracy of92.6%, with a sensitivity of95.7%, specificity of83.3%, positive predictive value of94.6%, negative predictive value of86.2%, positive likelihood ratio of5.7, and negative likelihood ratio of0.05. In patients with thick ligament or absorbed ligament the results of US and operative findings were totally same. The correspondence was not so high in patients with torn ligament with a sensitivity of94.6%, specificity of89.6%. Dividing torn ligaments into partial tears and complete tears, ultrasound allowed correct identification of17of20partial tears,38of54complete tears and43of48on tears. The sensitivity for partial tear was85.0%, the specificity was85.3%, and the accuracy was85.2%, while for the complete tear, the sensitivity was70.4%, the specificity was92.6%, and the accuracy was82.8%.Conclusions: High-resolution ultrasound can display the shape or continuity of the anterior talofibular ligament clearly.High-resolution ultrasound as a convenient technique with low costs and real time examination showed a satisfactory sensitivity and specificity for detecting ATFL injuries. Appearance of Achilles tendinitis on ultrasound[Abstract]Objective:To analyze the appearance of Achilles tendinitis on ultrasound, including the shape, microvascularity and calcifications of the Achilles tendinopathy. To evaluate clinical diagnostic value of high-resolution ultrasonography.Materials and Methods:Between January2012and March2013,129patients (97males and32females, mean age of37.5years, rang11-76years) with a clinical suspicion of Achilles tendinitis were taken US examination of the Achilles tendon. Among these patients,27cases including23males and4females, with a mean age of39.7years (range,23-67years), who were performed conservative treatment were reexamined.Real-time ultrasound scanning was performed with an IU-22US unit (Philips Medical Systems, Bothell, WA, USA). A wide frequency linear array transducer (5-17MHz) was used. The Achilles tendon was scanned from the lower end of the Gastrocnemius to the lower end of the Calcaneus. The shape, echo, continuity, microvascularity and calcifications of the Achilles tendon were recorded.In the scope of the examination:continuous tendon with normal size was regarded as grade0;the enlarged (more than10%) and uneven tendon was regarded as grade1; the obviously enlarged (more than20%) and discontinuous tendon was regarded as grade2.In the scope of the examination:It was regarded as grade0when there was no calcification in the Achilles tendon; It was regarded as grade1when there were1calcification to3calcifications in the Achilles tendon; It was regarded as grade2when there were more than3calcifications in the Achilles tendon.In the scope of the examination:It was regarded as grade0when there was no flow in the Achilles tendon; It was regarded as grade1when there were less than3flows in the Achilles tendon; It was regarded as grade2when there were more than3flows in the Achilles tendon. The shape, echo, continuity, microvascularity and calcifications of the27reexamined cases’ Achilles tendon were compared, the reasons which caused the pain of the Achilles tendinitis was summarized.Results:116of129cases’ Achilles tendon were found abnormal signs by the high-resolution ultrasound. Among these cases,33cases were mid-Achilles tendinitis,83cases were insertion-Achilles tendinitis.Among83cases of insertion-Achilles tendinitis, calcifications were found in61patients (73.5%), abnormal flows were found in53patients (63.9%) and abnormal shapes in58patients (69.9%).Among33cases of mid-Achilles tendinitis, calcifications were found in3patients (9.1%), abnormal flows were found in26patients (78.8%) and abnormal shapes in33patients (100.0%).27cases were performed conservative treatment. And symptoms disappeared. Among these cases, calcifications were reduced in5patients, calcifications were not changed in9patients, and13patients had no calcifications before the therapy. Flows were reduced in24cases, flows were not changed in2cases, and2cases were not found flows before the therapy.24cases tendons’shape got better,2cases tendons’shape didn’t changed, and1case tendon was normal in shape before the therapy.Conclusions:High-resolution ultrasound can displayed the shape, flows and calcifications of the Achilles tendinitis clearly. It is the first method for diagnosing the Achilles tendinitis.High-resolution ultrasound can also display the change of the shape and flows of the Achilles tendinitis clearly. It is the best method for the follow up patients with Achilles tendinitis.