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.
Keywords
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Article info
Publication history
Published online: January 05, 2023
Accepted:
December 9,
2022
Received in revised form:
December 8,
2022
Received:
July 27,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.
