Diagnostic accuracy of ultrasonography in acute lateral ankle ligament injury: A systematic review and meta-analysis

• Published in: Injury 2024-09, Vol.55, p.111730-111730, Article 111730
• Main Authors: Kocsis, Koppány, Stubnya, Bence, Váncsa, Szilárd, Kói, Tamás, Kovács, Norbert, Hergár, Luca, Hetthéssy, Judit, Holnapy, Gergely, Hegyi, Péter, Pap, Károly
• Format: Article
• Language: English
• Subjects: Acute injury; Ankle Injuries - diagnostic imaging; Ankle sprain; ATFL; CFL; Humans; Lateral Ligament, Ankle - diagnostic imaging; Lateral Ligament, Ankle - injuries; Magnetic Resonance Imaging; MRI; Orthopedics; Point-of-care ultrasound; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography - methods
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2024.111730

AbstractBackgroundThe gold standard diagnostic method for acute lateral ankle ligament sprain is magnetic resonance imaging (MRI). However, it is hardly accessible and is time-consuming. Therefore, additional diagnostic methods are warranted. Point-of-care ultrasound, on the other hand, is inexpensive, widely available, time-efficient testing method. PurposeTherefore, the aim of this meta-analysis is to determine the diagnostic accuracy of ultrasound for acute ankle ligament injuries compared to MRI. MethodsIn our systematic review and meta-analysis, we followed the recommendations of the Cochrane Handbook. We searched the following databases from inception to March 31, 2022: Medline (PubMed), EMBASE, and Cochrane Library. Eligible studies investigated the diagnostic accuracy of US compared to MRI for diagnosing acute lateral ankle ligament injuries. Finally, we calculated pooled sensitivity and specificity with a 95 % confidence interval (CI). ResultsEight studies met our eligibility criteria, involving 434 patients. For anterior tibiofibular ligament (ATFL) injury, the summary sensitivity and specificity were Se = 0.97 (CI: 0.89–0.99) and Sp = 0.93 (CI: 0.84–0.97). For calcaneofibular ligament (CFL) injury, the summary sensitivity and specificity were Se.: Se = 0.81 (CI: 0.58–0.93) and Sp = 0.92 [0,81;0,97]. In addition, subgroup analysis based on US performed by different types of investigators was comparable between each other (radiologist group Se = 0.98, CI: 0.24–1, and Sp = 0.91, CI: 0.74–0.97, and the orthopedic/ emergency department group Se = 0.96, CI: 0–1, and Sp = 0.97, CI: 0–1). ConclusionUltrasound showed high diagnostic accuracy for acute lateral ankle ligament injury, irrespective of the investigator. Therefore, based on the current available data, it could be used in primary diagnostics of acute lateral ankle ligament injury.