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Hattori S, Onishi K, Chan CK, Yamakawa S, Yano Y, Omodani T, Musahl V, Hogan MV, Debski RE. Optimal assessment for anterior talofibular ligament injury utilizing stress ultrasound entails internal rotation during plantarflexion. J ISAKOS 2024:S2059-7754(24)00029-4. [PMID: 38342182 DOI: 10.1016/j.jisako.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/11/2023] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES An optimal load and ankle position for stress ultrasound of the injured anterior talofibular ligament (ATFL) are unknown. The objectives of this study were to compare stress ultrasound and ankle kinematics from a 6 degree-of-freedom (6-DOF) robotic testing system as a reference standard for the evaluation of injured ATFL and suggest cut-off values for ultrasound diagnosis. METHODS Ten fresh-frozen human cadaveric ankles were used. Loads and ankle positions examined by the 6-DOF robotic testing system were: 40 N anterior load, 1.7 Nm inversion, and 1.7 Nm internal rotation torques at 30° plantarflexion, 15° plantarflexion, and 0° plantarflexion. Bony translations were measured by ultrasound and a robotic testing system under the above conditions. After measuring the intact ankle, ATFL was transected at its fibular attachment under arthroscopy. Correlations between ultrasound and robotic testing systems were calculated with Pearson correlation coefficients. Paired t-tests were performed for comparison of ultrasound measurements of translation between intact and transected ATFL and unloaded and loaded conditions in transected ATFL. RESULTS Good agreement between ultrasound measurement and that of the robotic testing system was found only in internal rotation at 30° plantarflexion (ICC = 0.77; 95% confidence interval 0.27-0.94). At 30° plantarflexion, significant differences in ultrasound measurements of translation between intact and transected ATFL (p < 0.01) were found in response to 1.7 Nm internal rotation torque and nonstress and stress with internal rotation (p < 0.01) with mean differences of 2.4 mm and 1.9 mm, respectively. CONCLUSION Based on the data of this study, moderate internal rotation and plantarflexion are optimal to evaluate the effects of ATFL injury when clinicians utilize stress ultrasound in patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Soichi Hattori
- MechanoBiology Laboratory, Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA 296-8602, USA; Department of Sports Medicine, Kameda Medical Center, Kamogawa, 15213, Japan.
| | - Kentaro Onishi
- MechanoBiology Laboratory, Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA 296-8602, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, PA 15213, USA; Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Calvin K Chan
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA 296-8602, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Satoshi Yamakawa
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA 296-8602, USA
| | - Yuji Yano
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA 296-8602, USA
| | - Toru Omodani
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA 296-8602, USA
| | - Volker Musahl
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA 296-8602, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - MaCalus V Hogan
- MechanoBiology Laboratory, Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA 296-8602, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Foot and Ankle Injury Research (FAIR) Group, Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Richard E Debski
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA 296-8602, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Shi J, Chang Q, Ma M, Wang P, Li J. Diagnostic value of measuring the talofibular space using stress sonography in chronic lateral ankle instability. Eur J Radiol 2024; 170:111273. [PMID: 38113672 DOI: 10.1016/j.ejrad.2023.111273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To investigate the diagnostic value of measuring the talofibular space using stress sonography for chronic lateral ankle instability (CLAI). MATERIALS & METHODS We recruited patients who were clinically diagnosed with CLAI between October 2018 and December 2019 (CLAI group). A control group of healthy volunteers was also included for this study. Both groups underwent a preliminary stress sonographic examination. First, the ultrasonic characteristics of the anterior talofibular ligament (ATFL), including length, thickness, relaxation, calcification, and rupture, were observed using conventional sonography. Second, the talofibular space at the passive neutral position (D1) and maximum varus position (D2) was measured (by stress sonographic images), and the difference (ΔD = D1-D2) between them was determined. Third, the parameters of the two groups were statistically compared. Finally, receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were performed for parameters with significant differences. RESULTS The CLAI group comprised 60 patients, yielding data on 60 ankles, whereas the control group comprised 35 participants, yielding data for 70 ankles. Differences in D1, D2, and ΔD of the talofibular space between the two groups were significant, with ΔD proving to be the best diagnostic indicator (P < 0.001). Its AUC, optimal cutoff value, sensitivity, and specificity were 0.922, 0.11 cm, 73 %, and 94 %, respectively, followed by D2 (0.850, 0.47 cm, 67 %, and 94 %, respectively; P < 0.001) and D1 (0.635, 0.47 cm, 67 %, and 94 %, respectively; P = 0.006). CONCLUSION Measurement of talofibular space in stress sonography is a valuable diagnostic indicator for CLAI, especially the ΔD between the neutral and stress position.
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Affiliation(s)
- Jinjun Shi
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Qin Chang
- Department of Orthopedics, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Ming Ma
- Department of Rehabilitation, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Pingping Wang
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Jia Li
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
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Iwata S, Yamaguchi S, Kimura S, Hattori S, Mikami Y, Kawasaki Y, Shiko Y, Akagi R, Amaha K, Atsuta T, Ikegawa N, Koyama M, Nakagawa R, Omodani T, Ouchi H, Saito M, Takahashi K, Watanabe S, Sasho T, Ohtori S. Variability in sonographic anterior drawer test measurements of the ankle: Experienced versus beginner examiners. J Orthop Sci 2024; 29:243-248. [PMID: 36610840 DOI: 10.1016/j.jos.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aimed to clarify the variability in the measurements of stress sonography of the ankle and determine the effects of examiner experience on the measurements. METHODS Twenty examiners (10 experienced and 10 beginners) were included in the study. Each examiner performed stress ultrasonography on a patient with a chronic anterior talofibular ligament injury and a patient with an intact ligament using the reverse anterior drawer method. Changes in ligament length before versus after stress were determined. The same 20 examiners performed ultrasonography on two other patients with an injured or intact ATFL using the anterior drawer method. The length change values and variance were compared between the groups using t-tests and F-tests. RESULTS Using the reverse anterior drawer method, the change in the anterior talofibular ligament length was 3.3 mm (range, 2.2-4.8 mm) in the experienced group and 2.7 mm (0.0-4.1 mm) in the beginner group for the ligament injured patient. The length changes for the patient with intact anterior talofibular ligament were 0.5 mm (0.1-0.9 mm) and 0.4 mm (-0.1-1.5 mm) in the experienced and beginner groups, respectively. There were no significant intergroup differences in measurement amount (P = 0.37) or variance (P = 0.72). Similarly, using the anterior drawer method, no significant differences between the groups were found in measurement amount or variance. CONCLUSION The quantitative evaluation of stress sonography of the ankle was variable regardless of examiner experience or stress method, particularly in patients with an anterior talofibular ligament injury. The amount of variability appeared to be unacceptably large for clinical application. Our study results highlight the need for technical standardization.
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Affiliation(s)
- Shuhei Iwata
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan.
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Soichi Hattori
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yukio Mikami
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Kentaro Amaha
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | | | - Naoshi Ikegawa
- Department of Orthopaedic Surgery, Kashiwa City Hospital, Chiba, Japan
| | - Minoru Koyama
- Division of Rehabilitation, Kameda Medical Center, Kamogawa, Japan
| | - Ryosuke Nakagawa
- Department of Orthopaedic Surgery, Kohnodai Hospital, Tokyo, Japan
| | | | - Hiroshi Ouchi
- Department of Sports Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Masahiko Saito
- Department of Orthopaedic Surgery, Chiba Medical Center, Chiba, Japan
| | - Kenji Takahashi
- Sports Medicine &; Joint Center, Funabashi Orthopaedic Hospital, Chiba, Japan
| | - Shotaro Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
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Iwata S, Yamaguchi S, Kimura S, Hattori S, Sasahara J, Akagi R, Amaha K, Atsuta T, Kanzaki N, Noguchi K, Okada H, Omodani T, Ohuchi H, Sato H, Takada S, Takahashi K, Yamada Y, Yasui T, Yokoe T, Fukushima S, Iida D, Ono Y, Kawasaki Y, Shiko Y, Sasho T, Ohtori S. Do standardization of the procedure reduce measurement variability of the sonographic anterior drawer test of the ankle? J Orthop Sci 2023:S0949-2658(23)00320-2. [PMID: 37996296 DOI: 10.1016/j.jos.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND In quantitative ankle stress sonography, different examiners use different techniques, which may cause measurement variability. This study aimed to clarify whether standardizing stress sonography techniques reduces variability in the quantitative measurement of anterior talofibular ligament length change. METHODS Fourteen examiners with a mean ultrasound experience of 8.7 years participated in this study. Each examiner performed stress ultrasonography of the ankle using their preferred method on one patient with an intact anterior talofibular ligament (Patient 1) and on two patients with chronic ankle instability (Patient 2 and 3). Changes in the ligament length between the resting and stressed positions were determined. A consensus meeting was then conducted to standardize the sonographic technique, which was used by the examiners during a repeat stress sonography on the same patients. The variance and measured values were compared between the preferred and standardized techniques using F-tests and paired t-tests, respectively. RESULTS At a consensus meeting, a sonographic technique in which the examiner pushed the lower leg posteriorly against the fixed foot was adopted as the standardized technique. In Patient 1, the change in the anterior talofibular ligament length was 0.4 (range, -2.3-1.3) mm and 0.6 (-0.6-1.7) mm using the preferred and standardized techniques, respectively, with no significant difference in the variance (P = 0.51) or the measured value (P = 0.52). The length changes in Patient 2 were 2.0 (0.3-4.4) mm and 1.7 (-0.9-3.8) mm using the preferred and standardized techniques, respectively. In Patient 3, the length changes were 1.4 (-2.7-7.1) mm and 0.7 (-2.0-2.3) mm. There were no significant differences between the techniques in either patient group. CONCLUSION Variability in the quantitative measurement of ankle stress sonography was not reduced despite the standardization of the technique among examiners. Hence, comparing the measured values between different examiners should be avoided.
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Affiliation(s)
- Shuhei Iwata
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan.
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Soichi Hattori
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Jun Sasahara
- Institute of Sports Science & Medicine, Teikyo University, Tokyo, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Oyumino Central Hospital, Chiba, Japan
| | - Kentaro Amaha
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | | | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Koji Noguchi
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Kurume General Hospital, Fukuoka, Japan
| | | | | | - Hiroshi Ohuchi
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Hiroyuki Sato
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Satoshi Takada
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Kenji Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Chiba, Japan
| | - Yuichi Yamada
- Institute for Integrated Sports Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shun Fukushima
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Daisuke Iida
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Yoshimasa Ono
- Department of Orthopaedic Surgery, Numazu City Hospital, Shizuoka, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
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Murahashi Y, Teramoto A, Takahashi K, Okada Y, Okimura S, Imamura R, Kawai M, Watanabe K, Yamashita T. High reproducibility of a novel supported anterior drawer test for diagnosing ankle instability. BMC Musculoskelet Disord 2023; 24:148. [PMID: 36849957 PMCID: PMC9969681 DOI: 10.1186/s12891-023-06246-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The manual traditional anterior drawer test (ADT) is essential for deciding the treatment for chronic ankle instability, but it has been shown to have a comparatively low reproducibility and accuracy, especially in less experienced hands. To clarify the inter-examiner reproducibility, we compared the actual distance of anterior translation between junior and senior examiners in ADT. We also evaluated the diagnostic abilities of traditional ADT, and a novel modified ADT (supported ADT). METHODS Thirty ankles were included in this study, and ankle instability was defined using stress radiography. All subjects underwent two methods of manual ADT by junior and senior examiners, and ankle instability was judged in a blinded fashion. The anterior drawer distance was calculated from the lengthening measured using a capacitance-type sensor device. RESULTS The degree of anterior translation determined by the junior examiner was significantly lower than that determined by the senior examiner when traditional ADT was performed (3.3 vs. 4.5 mm, P = 0.016), but there was no significant difference in anterior translation between the two examiners when supported ADT was performed (4.6 vs. 4.1 mm, P = 0.168). The inter-examiner reliability of supported ADT was higher than that of traditional ADT. For the junior examiner, the diagnostic accuracy of supported ADT was higher than that of traditional ADT (sensitivity, 0.40 vs. 0.80; specificity, 0.75 vs. 0.80). CONCLUSION Supported ADT may have the advantage of being a simple manual test of ankle instability with less error between examiners.
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Affiliation(s)
- Yasutaka Murahashi
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543, Japan.
| | - Katsunori Takahashi
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Yohei Okada
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Shinichiro Okimura
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Rui Imamura
- grid.470107.5Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Makoto Kawai
- grid.470107.5Division of Rehabilitation, Sapporo Medical University Hospital, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Kota Watanabe
- grid.263171.00000 0001 0691 0855Department of Physical Therapy, Sapporo Medical University School of Health Sciences, S-1, W-17, Chuo-Ku, Sapporo, 060-8556 Japan
| | - Toshihiko Yamashita
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
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Reliability and validity of ultrasonographic automated length measurement system for assessing talofibular anterior instability in acute lateral ankle sprain. Sci Rep 2023; 13:3098. [PMID: 36813849 PMCID: PMC9947169 DOI: 10.1038/s41598-023-30079-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Ankle joint instability after acute lateral ankle sprain (LAS) is an important factor for deciding treatment strategies. Nevertheless, the degree of ankle joint mechanical instability as a criterion for making clinical decisions is unclear. This study examined the reliability and validity of an Automated Length Measurement System (ALMS) in ultrasonography for assessing real-time anterior talofibular distance. Using a phantom model, we tested whether ALMS could detect two points within a landmark following movement of the ultrasonographic probe. Furthermore, we examined whether ALMS was comparable with the manual measurement method for 21 patients with an acute LAS (42 ankles) during the reverse anterior drawer test. Using the phantom model, ALMS measurements showed excellent reliability, with errors below 0.4 mm and with a small variance. The ALMS measurement was comparable to manually measured values (ICC = 0.53-0.71, p < 0.001) and detected differences in talofibular joint distances between unaffected and affected ankles of 1.41 mm (p < 0.001). ALMS shortened the measurement time by one-thirteenth for one sample compared to the manual measurement (p < 0.001). ALMS could be used to standardize and simplify ultrasonographic measurement methods for dynamic joint movements without human error in clinical applications.
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Chen Y, Cao S, Wang C, Ma X, Wang X. Quantitative analysis with load–displacement ratio measured via digital arthrometer in the diagnostic evaluation of chronic ankle instability: a cross-sectional study. J Orthop Surg Res 2022; 17:287. [PMID: 35606774 PMCID: PMC9125832 DOI: 10.1186/s13018-022-03177-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/17/2022] [Indexed: 12/26/2022] Open
Abstract
Background Arthrometry has been introduced to evaluate the laxity of ankle joint in recent years. However, its role in the diagnosis of chronic ankle instability is still debatable. Therefore, we assessed the diagnostic accuracy of a digital arthrometer in terms of sensitivity and specificity. Methods According to the inclusion and exclusion criteria proposed by the International Ankle Consortium, we recruited 160 uninjured ankles (control group) and 153 ankles with chronic ankle instability (CAI group). Ankle laxity was quantitively measured by a validated digital arthrometer. Data of loading force and joint displacement were recorded in a continuous manner. Differences between the control and CAI groups were compared using 2-tailed independent t test. A receiver operating characteristic curve analysis was used to calculate area under a curve, sensitivity and specificity. Results Load–displacement curves of the two groups were depicted. Differences of joint displacement between the control and CAI groups were compared at 30, 45, 60, 75, 90, 105 and 120 N, which were all of statistical significance (all p < 0.001) with the largest effect size at 90 N. Statistical significance was found in the differences between the two groups in load–displacement ratio at 10–120 N, 10–40 N, 40–80 N and 80–120 N (all p < 0.001), with the largest effect size at 10–40 N. Load–displacement ratio at the interval of 10–40 N had the highest area under a curve (0.9226), with sensitivity and specificity of 0.804 and 0.863, respectively, when the cutoff point was 0.1582 mm/N. Conclusion The digital arthrometer measurement could quantitively analyze the ankle laxity with high diagnostic accuracy. The load–displacement ratio would be a reliable and promising approach for chronic ankle instability diagnosis. Level of evidence level II.
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Netterström-Wedin F, Matthews M, Bleakley C. Diagnostic Accuracy of Clinical Tests Assessing Ligamentous Injury of the Talocrural and Subtalar Joints: A Systematic Review With Meta-Analysis. Sports Health 2021; 14:336-347. [PMID: 34286639 PMCID: PMC9109591 DOI: 10.1177/19417381211029953] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Context: Ankle sprains are the most common acute musculoskeletal injury. Clinical tests represent the first opportunity to assess the sprain’s severity, but no systematic review has compared these tests to contemporary reference standards. Objective: To determine the diagnostic accuracy of clinical tests assessing the talocrural and subtalar joint ligaments after ankle sprain. Data Sources: CINAHL, EMBASE, MEDLINE, hand-searching, and PubMed-related article searches (inception to November 18, 2020). Study Selection: Eligible diagnostic studies compared clinical examination (palpation, joint laxity) against imaging or surgery. Studies at a high risk of bias or with high concerns regarding applicability on Quality Assessment of Diagnostic Accuracy Studies-2 were excluded from the meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3a. Data Extraction: True-positive, false-negative, false-positive, and true-negative findings were extracted to calculate sensitivity, specificity, and likelihood ratios. If ordinal data were reported, these were extracted to calculate Cohen’s kappa. Results: A total of 14 studies met the inclusion criteria (6302 observations; 9 clinical tests). No test had both sensitivity and specificity exceeding 90%. Palpation of the anterior talofibular ligament is highly sensitive (sensitivity 95%-100%; specificity 0%-32%; min-max; n = 6) but less so for the calcaneofibular ligament (sensitivity 49%-100%; specificity 26%-79%; min-max; n = 6). Pooled data from 6 studies (885 observations) found a low sensitivity (54%; 95% CI 35%-71%) but high specificity (87%; 95% CI 63%-96%) for the anterior drawer test. Conclusion: The anterior talofibular ligament is best assessed using a cluster of palpation (rule out), and anterior drawer testing (rule in). The talar tilt test can rule in injury to the calcaneofibular ligament, but a sensitive clinical test for the ligament is lacking. It is unclear if ligamentous injury grading can be done beyond the binary (injured vs uninjured), and clinical tests of the subtalar joint ligaments are not well researched. The generalizability of our findings is limited by insufficient reporting on blinding and poor study quality. Registration: Prospero ID: CRD42020187848. Data Availability: Data are available in a public, open access repository on publication, including our RevMan file and the CSV file used for meta-analysis: http://doi.org/10.5281/zenodo.4917138
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Affiliation(s)
| | - Mark Matthews
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK
| | - Chris Bleakley
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Jordanstown Campus, Antrim, UK
- Chris Bleakley, PhD, Ulster University, Jordanstown Campus, Room 01F118, Shore Road, Newtownabbey Co, Antrim BT37 0QB, UK ()
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Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG80. [PMID: 33789434 DOI: 10.2519/jospt.2021.0302] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.
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Xu R, Zuo H, Ji Y, Li Q, Wang Z, Liu H, Wang J, Wei Z, Li W, Cong L, Li H, Jin H, Wang J. Effects of Short-Term Limitation of Movement of the First Metatarsophalangeal Joint on the Biomechanics of the Ipsilateral Hip, Knee, and Ankle Joints During Walking. Med Sci Monit 2021; 27:e930081. [PMID: 33664219 PMCID: PMC7941761 DOI: 10.12659/msm.930081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We analyzed the effect of limitation of movement of the first metatarsophalangeal joint (FMJ) on the biomechanics of the lower limbs during walking. MATERIAL AND METHODS Eight healthy college students completed walking under barefoot (BF) and FMJ constraint (FMJC) conditions. We synchronously collected kinematics and dynamics data, and calculated the torque, power, and work of hip, knee, and ankle joints. RESULTS Compared with normal conditions, when the FMJ is restricted from walking, the maximum ankle dorsiflexion angle is significantly increased (P<0.001), the maximum plantar flexion angle is significantly reduced (P<0.001), the maximum plantar flexion torque (P<0.001) and the maximum dorsiflexion torque (P<0.05) increased significantly, the maximum power increased significantly (P<0.001), the minimum power decreased significantly (P<0.001), and the negative work increased significantly (P<0.001). The torque of hip and knee joints increased significantly (P<0.05). CONCLUSIONS After the movement of the FMJ is restricted, the human body mainly compensates and transfers compensation by increasing the angle of dorsiflexion, increasing work and the activity level of surrounding muscles through the ankle joint, thereby increasing the torque load of the knee and hip joints to maintain the dynamic balance of kinematics. FMJC condition increases the energy consumption of the human ankle, knee, and hip joints during walking. The load is compensated by the gradual attenuation of the ankle, knee, and hip. Long-term limitation may cause damage to the posterior calf muscles and increase the incidence of knee arthritis.
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Affiliation(s)
- Rui Xu
- Department of Endocrinology, Shanghai National Research Center for Endocrine and Metabolic Disease, State Key Laboratory of Medical Genomics, Shanghai Institute for Endocrine and Metabolic Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland).,Department of Clinical Medicine, Norman Bethune Health Science Center of Jilin University, Changchun, Jilin, China (mainland)
| | - Hao Zuo
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Youbo Ji
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Qiang Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - He Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Jiarui Wang
- Department of Clinical Medicine, Norman Bethune Health Science Center of Jilin University, Changchun, Jilin, China (mainland)
| | - Zheyi Wei
- Department of Clinical Medicine, Fudan University School of Medicine, Shanghai, China (mainland)
| | - Weihang Li
- Department of Orthopaedics, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China (mainland)
| | - Lin Cong
- Department of Bioengineering, School of Public Health, Jilin University, Changchun, Jilin, China (mainland)
| | - Han Li
- Department of Clinical Medicine, Norman Bethune Health Science Center of Jilin University, Changchun, Jilin, China (mainland)
| | - Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Jincheng Wang
- Orthopaedic Medical Centre, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
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Abstract
Foot and ankle instability can be seen both in acute and chronic settings, and isolating the diagnosis can be difficult. Imaging can contribute to the clinical presentation not only by identifying abnormal morphology of various supporting soft tissue structures but also by providing referring clinicians with a sense of how functionally incompetent those structures are by utilizing weight-bearing images and with comparison to the contralateral side. Loading the affected joint and visualizing changes in alignment provide clinicians with information regarding the severity of the abnormality and, therefore, how it should be managed.
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Affiliation(s)
- Carolyn M Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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