Dynamic high-resolution ultrasound in the diagnosis of calcaneofibular ligament injury in chronic lateral ankle injury: a comparison with three-dimensional magnetic resonance imaging.

PURPOSE: To date, no gold standard imaging method has been used to assess calcaneofibular ligament (CFL) injuries. Ultrasound (US) has become increasingly important in the assessment of ligaments around the ankle. However, very few reports in the literature have focused on detecting CFL injuries. The objective of this study was to determine the effectiveness of ultrasound in detecting CFL injuries in comparison with magnetic resonance imaging (MRI). METHODS: A retrospective study was conducted in 21 patients with chronic lateral ankle injury, 10 males and 11 females with a mean age of 27.6 ± 14.5 years (range 14-68 years). High-frequency US and three-dimensional (3D) MRI of the affected ankle were performed. Evaluations of the CFL were performed by two orthopedic surgeons experienced in US, while the MRI findings were interpreted by two musculoskeletal radiologists. The US findings were then compared with the MRI findings. RESULTS: US detected CFL injury in 9/21 patients, and these findings were confirmed by the MRI findings. However, one patient with a normal CFL on US was evaluated as laxity on MRI. In this study, US sensitivity and specificity in detecting CFL injuries was 90% (9/10) and 100% (10/10), respectively, with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 91.7% in comparison with MRI. CONCLUSION: With the proper technique and knowledge of the ankle anatomy, high-frequency US proved to be an effective imaging modality in the diagnosis of CFL lesions in chronic lateral ankle injuries. US had a high sensitivity and specificity in the evaluation of the CFL when MRI findings were regarded as the reference standard.

Ultrasound-Guided Ankle Lateral Ligament Stabilization.

PURPOSE OF REVIEW: Ultrasound (US) is an increasingly popular imaging modality currently used both in clinics and operating rooms. The purpose of this review is to appraise literature describing traditional lateral ankle stabilization techniques and discuss potential advantages of US-guided ankle lateral ligament stabilization. In addition, albeit limited, we will describe our experiences in perfecting this technique. RECENT FINDINGS: To date, the modified open Broström-Gould technique remains as the gold standard surgical treatment for chronic ankle instability (CAI). In the past decade, modifications of this technique have been done, from a combination of arthroscopic and open procedure to an all-inside arthroscopic technique with a goal of minimizing wound complications, better outcomes, and earlier return to activity. Recently, the use of US as an adjunct to surgical procedures has gained popularity and several novel techniques have been described. The use of US in lateral ankle stabilization could allow accurate placement of the suture anchor at the anatomical attachment of the anterior talofibular ligament (ATFL) without iatrogenic damage to the neurovascular structures such as anterolateral malleolar artery, superficial peroneal nerve, and sural nerve. In summary, the use of US in ankle lateral ligament stabilization is a promising new micro-invasive technique. The theoretical advantages of US-guided ankle lateral ligament stabilization include direct visualization of desired anatomical landmarks and structures which could increase accuracy, decrease iatrogenic neurovascular damage, minimize wound complications, and improve outcomes.

Changes in calcaneal pitch and heel fat pad thickness in static weight bearing radiographs while wearing shoes with arch support and heel cup orthotics.

BACKGROUND: Foot orthoses have been shown to reduce the collapse of the longitudinal arch and to constrain soft tissue displacement under the heel. However, there has not been a study that has shown the effectiveness of both the arch and heel features in the same orthosis. This study quantitatively analyzed if the calcaneal pitch and the heel pad thickness will be affected by the use of an arch support and heel cup insole in a static weightbearing stance while wearing sports shoes. METHODS: Twenty-four (24) feet from 12 elite-level female soccer players with a mean age of 25 ±â€¯3.99 years (20-33 years old) were studied. Lateral weightbearing radiographs with and without orthotics were obtained in order to measure the calcaneal pitch angle and heel fat pad thickness for each foot. A subjective outcome measure was used and the scores were classified as bad (0-2), fair (3-5), good (6-8), or excellent (9-10). RESULTS: The calcaneal pitch angle increased in all but three cases by an average of 1.05° (range, -1.14 to 3.19) after wearing orthotics (p < 0.01). The heel fat pad thickness increased in all cases with an average of 1.25 mm (range, 1.05 to 1.47; p < 0.01)). 9 of 12 subjects (75%) reported excellent (n = 2) or good (n = 7) overall subjective scores with insole wear. CONCLUSION: Under static weightbearing conditions, the arch support and heel cup features of a foot orthosis help improve the height of the calcaneal pitch and the thickness of the heel fat pad, respectively.