title: Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy.
abstract: OBJECTIVE
  Clinicians frequently diagnose chronic ankle instability using the manual anterior drawer test and stress radiography. However, both examinations can yield incorrect results and do not reveal the extent of ankle instability. Stress ultrasound has been reported to be a new diagnostic tool for the diagnosis of chronic ankle instability. The purpose of this study was to assess the diagnostic value of stress ultrasound for chronic ankle instability compared to the manual anterior drawer test, stress radiography, magnetic resonance imaging (MRI), and arthroscopy.
  
  
  METHODS
  Twenty-eight consecutive patients who underwent ankle arthroscopy and subsequent modified Broström repair for treatment of chronic ankle instability were included. The arthroscopic findings were used as the reference standard. A standardized physical examination (manual anterior drawer test), stress radiography, MRI, and stress ultrasound were performed to assess the anterior talofibular ligament (ATFL) prior to operation. Ultrasound images were taken in the resting position and the maximal anterior drawer position.
  
  
  RESULTS
  Grade 3 lateral instability was verified arthroscopically in all 28 cases with a clinical diagnosis (100%). Twenty-two cases showed grade III instability on the manual anterior drawer test (78.6%). Twenty-four cases displayed anterior translation exceeding 5 mm on stress radiography (86%), and talar tilt angle exceeded 15° in three cases (11 %). Nineteen cases displayed a partial chronic tear (change in thickness or signal intensity), and nine cases displayed complete tear on MRI (100%). Lax and wavy ATFL was evident on stress ultrasound in all cases (100 %). The mean value of the ATFL length was 2.8 ± 0.3 cm for the stressed condition and 2.1 ± 0.2 cm for the resting condition (p < 0.001).
  
  
  CONCLUSIONS
  Stress ultrasound may be useful for the diagnosis of chronic ankle instability in addition to the manual anterior drawer test and stress radiography.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
authors.forename: Doo Hyung
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
authors.forename: Hyung Keun
authors.initials: HK
authors.lastname: Song
authors.affiliation: Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Bang
authors.affiliation: Foot and Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Republic of Korea.
authors.forename: Kyung Tai
authors.initials: KT
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea. parkyounguk@gmail.com.
authors.forename: Young Uk
authors.initials: YU
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000842:Ankle / Q000000981:diagnostic imaging; D000843:Ankle Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D001182:Arthroscopy; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D017844:Lateral Ligament, Ankle; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult
keywords: Anterior talofibular ligament; Chronic ankle instability; Stress ultrasound