An accuracy evaluation of clinical, arthrometric, and stress-sonographic acute ankle instability examinations

• We investigate the validity of stress ultrasounds in the ankle.
• Clinical examination and an arthrometer method were compared to stress ultrasound.
• We use adequate analgesia.
• We quantified the sensitivities and specificities.
• Examination is the most reliable tool to investigate ligamentous ankle lesions.

BackgroundAnkle sprain injuries, often due to lateral ligamentous injury, are the most common sports traumatology conditions. Correct diagnoses require an understanding of the assessment tools with a high degree of diagnostic accuracy. Obviously, there are still no clear consensuses or standard methods to differentiate between a ligament tear and an ankle sprain. In addition to clinical assessments, stress sonography, arthrometer and other methods are often performed simultaneously. These methods are often costly, however, and their accuracy is controversial. The aim of this study was to investigate three different measurement tools that can be used after a lateral ligament lesion of the ankle with injury of the anterior talofibular ligament to determine their diagnostic accuracy.MethodsThirty patients were recruited for this study. The mean patient age was 35 ± 14 years. There were 15 patients with a ligamentous rupture and 15 patients with an ankle sprain. We quantified two devices and one clinical assessment by which we calculated the sensitivity and specifity: Stress sonography according to Hoffmann, an arthrometer to investigate the 100 N talar drawer and maximum manual testing and the clinical assessment of the anterior drawer test. A high resolution sonography was used as the gold standard.ResultsThe ultrasound-assisted gadgetry according to Hoffmann, with a 3 mm cut-off value, displayed a sensitivity of 0.27 and a specificity of 0.87. Using a 3.95 mm cut-off value, the arthrometer displayed a sensitivity of 0.8 and a specificity of 0.4. The clinical investigation sensitivities and specificities were 0.93 and 0.67, respectively.ConclusionsDifferent assessment methods for ankle rupture diagnoses are suggested in the literature; however, these methods lack reliable data to set investigation standards.Clinical examination under adequate analgesia seems to remains the most reliable tool to investigate ligamentous ankle lesions. Further clinical studies with higher case numbers are necessary, however, to evaluate these findings and to measure the reliability.