CME OnDemand: Novel Imaging and MIS Techniques in Foot and Ankle Care (2026)-Value of ultrasonography for detecting chronic injury of the lateral ligaments of the ankle joint compared with ultrasonography findings

Value of ultrasonography for detecting chronic injury of the lateral ligaments of the ankle joint compared with ultrasonography findings

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This prospective study evaluated how accurately ultrasonography (US) diagnoses chronic lateral ankle ligament injuries when compared with intraoperative/arthroscopic findings as the reference standard. The authors examined 120 patients (120 ankles) with lateral ankle pain for at least 6 weeks after sprain who later underwent surgery. Preoperative US was performed using a 5–17 MHz linear transducer by an experienced radiologist blinded to other clinical/imaging results; surgeons were also blinded to US findings. Ligament status was graded on US and at surgery as: Grade 0 (normal), Grade 1 (sprain/swelling), Grade 2 (partial tear), and Grade 3 (complete tear).<br /><br />Surgical findings showed lateral ligament injury in 94/120 patients (78.3%). Specifically, the anterior talofibular ligament (ATFL) had 18 sprains, 24 partial tears, and 52 complete tears; the calcaneofibular ligament (CFL) had 26 sprains, 27 partial tears, and 12 complete tears; and there was one posterior talofibular ligament (PTFL) complete tear. US detected ATFL injury in 93/94 cases and CFL injury in 61/65 cases, and it identified the single PTFL tear.<br /><br />Against operative findings, US performance was high: for ATFL injury, sensitivity 98.9%, specificity 96.2%, accuracy 84.2%; for CFL injury, sensitivity 93.8%, specificity 90.9%, accuracy 83.3%. Accuracy did not differ between “acute-on-chronic” (<4 weeks since a recent sprain) and subacute–chronic cases. Limitations included reduced sensitivity for low-grade ATFL injuries and for complete CFL tears (partly due to anatomy and technical factors such as anisotropy), plus potential mismatch where scar tissue mimicked intact ligament.<br /><br />The authors conclude that ultrasonography is a low-cost, real-time, clinically useful tool with high sensitivity and specificity for evaluating chronic lateral ankle ligament injury, although operator expertise and standardized criteria are important.

Keywords

ultrasonography

chronic lateral ankle ligament injury

anterior talofibular ligament (ATFL)

calcaneofibular ligament (CFL)

posterior talofibular ligament (PTFL)

arthroscopic intraoperative reference standard

diagnostic accuracy

sensitivity and specificity

ligament tear grading (Grade 0–3)

anisotropy and scar tissue pitfalls