Value of ultrasonography for detecting ligament damage in athletes with chronic ankle instability compared to computed arthrotomography

Abstract

Ankle sprains may be followed by chronic pain and/or instability, which may induce substantial disability, most notably in athletes. Chronic ankle instability promotes the development of cartilage lesions in athletes. Therefore, accurate evaluation of the ankle ligaments is crucial to the optimal management of chronic ankle instability after a sprain. The objective of this study was to assess the performance of ultrasonography in assessing damage to the anterior talofibular ligament (ATFL) in athletes with chronic ankle instability after a sprain. Consecutive patients seen at the author's clinic for ankle instability more than 3 months after a sprain underwent ultrasonography and computed arthrotomography after a clinical anterior drawer stress test. Cohen's kappa was computed to evaluate agreement between the 2 imaging modalities. This study included 56 patients, 46 men and 10 women, aged 15 to 69 years (mean, 30.1 ± 10.6 years). Mean time from the sprain to imaging was 7.6 ± 4.02 months. ATFL damage was found by ultrasonography in 34 (61%) of 56 patients and by computed arthrotomography in 39 of 55 patients (71%; κ = 0.76). Cartilage damage was visualized by computed arthrotomography in 14 (25%) patients, all of whom had ATFL damage. Agreement was substantial (κ = 0.76) between ultrasonography and computed arthrotomography for assessing the ATFL. The data support the use of ultra-sonography as the second-line investigation after a standard radiographic assessment in athletes with chronic ankle instability after a sprain.