title: An accuracy evaluation of clinical, arthrometric, and stress-sonographic acute ankle instability examinations.
abstract: BACKGROUND
  Ankle 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.
  
  
  METHODS
  Thirty 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 100N 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.
  
  
  RESULTS
  The ultrasound-assisted gadgetry according to Hoffmann, with a 3mm cut-off value, displayed a sensitivity of 0.27 and a specificity of 0.87. Using a 3.95mm 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.
  
  
  CONCLUSIONS
  Different 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.
authors: Department of Trauma Surgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Electronic address: U.Wiebking@t-online.de.
authors: Ulrich
authors: U
authors: Wiebking
authors: Department of Trauma and Orthopaedic Surgery, Klinikum Neustadt am Rübenberge, Lindenstr. 75, 31535 Neustadt am Rübenberge, Germany.
authors: Tarek Omar
authors: TO
authors: Pacha
authors: Department of Trauma Surgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors: Michael
authors: M
authors: Jagodzinski
mesh_terms: D000328:Adult; D000842:Ankle / Q000000981:diagnostic imaging; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D000843:Ankle Joint / Q000000981:diagnostic imaging; D053587:Arthrometry, Articular; D005080:Exercise Test; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis*; D017844:Lateral Ligament, Ankle / Q000000981:diagnostic imaging* / Q000293:injuries*; D008023:Ligaments, Articular / Q000293:injuries; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012421:Rupture; D012680:Sensitivity and Specificity; D013180:Sprains and Strains / Q000175:diagnosis*; D014463:Ultrasonography; D055815:Young Adult
keywords: Acute lateral ankle lesion; Ankle sprain; Anterior drawer test; Assessment; Sonography