Meta-analysis of MRI in diagnosing lateral ankle ligament injury
DONG Hui1,2, LIU Shujing1,3, LU Guangxu1,3, REN Xingkuan4, WANG Wenliang3
1.Logistics University of Chinese People's Armed Police Force, Tianjin 300309,China; 2.Health Company of Army 32134, Tianjin 301900,China; 3.Department of Orthopedics,Featured Medical Center of Chinese People's Armed Police Force, Tianjin 300162,China; 4.Tianjin University of Traditional Chinese Medicine, Tianjin 300162, China
Abstract：Objective To investigate the effectiveness of magnetic resonance imaging (MRI) in diagnosing lateral ankle ligament injury by meta-analysis.Methods Such databases as Chinese Journal Full-text Database, Wanfang Database, Chinese Science and Technology Database, PubMed, EMbase and the Cochrane Library were searched from inception to November 2018. Eligible studies were summarized. Data was extracted to calculate the pooled sensitivity and specificity of MRI in the diagnosis of lateral ankle ligament injury.Results Sixteen studies met the inclusion criteria and a total of 660 participants were included. The pooled sensitivity of MRI in diagnosing acute ATFL injury was 0.93 [95% CI (0.86, 0.97)], and the specificity was 0.55 [95% CI (0.27, 0.80)]. The pooled sensitivity in diagnosing chronic ATFL injury was 0.86 [95% CI (0.77, 0.91)], and the specificity was 0.80[95% CI (0.67, 0.89)]. The pooled sensitivity in diagnosing acute CFL injury was 0.72 [95% CI (0.58, 0.82)], and the specificity was 0.86 [95% CI (0.68, 0.95)]. The pooled sensitivity in diagnosing chronic CFL injury was 0.57 [95% CI (0.44, 0.69)], and the specificity was 0.92 [95% CI (0.86, 0.96)].Conclusions MRI can serve as an effective and feasible method in diagnosing chronic ATFL injuries. MRI can effectively screen patients with ATFL injury. In the diagnosis of CFL injury, acute or chronic, the negative results are of some value for the exclusion of CFL injury.
Hunt K J, Hurwit D, Robell K,et al. Incidence and epidemiology of foot and ankle injuries in elite collegiate athletes [J]. Am J Sports Med, 2016, 45(2): 426-433.
[2]
Karlsson J, Sancone M. Management of acute ligament injuries of the ankle [J]. Foot Ankle Clin, 2006, 11(3): 521-530.
Mailuhu A K E, Oei E H G, Van Putte-Katier N, et al. Clinical and radiological predictors for persistent complaints five years after a lateral ankle sprain: A long-term follow-up study in primary care [J]. J Sci Med Sport, 2018, 21(3): 250-256.
[5]
Hertel, Jay. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability [J].J Athl Train, 2002, 37(4): 364-375.
[6]
Jolman S, Robbins J, Lewis L, et al. Comparison of magnetic resonance imaging and stress radiographs in the evaluation of chronic lateral ankle instability [J]. Foot Ankle Int, 2017, 38(4): 397-404.
[7]
Shakked R J, Karnovsky S, Drakos M C,et al. Operative treatment of lateral ligament instability [J]. Curr Rev Musculoskelet Med, 2017, 10(1): 113-121.
[8]
Cha S D, Kim H S, Chung S T, et al. Intra-articular lesions in chronic lateral ankle instability: comparison of arthroscopy with magnetic resonance imaging findings [J]. Clin Orthop Surg, 2012, 4(4): 293-299.
[9]
Kim Y S, Kim Y B, Kim T G, et al. Reliability and validity of magnetic resonance imaging for the evaluation of the anterior talofibular ligament in patients undergoing ankle arthroscopy [J]. Arthroscopy, 2015, 31(8): 1540-1547.
[10]
Lee M H, Cha J G, Lee Y K,et al. The bright rim sign on MRI for anterior talofibular ligament injury with arthroscopic correlation [J]. AJR Am J Roentgenol, 2012, 198(4): 885-890.
[11]
Whiting P, Rutjes A W, Reitsma J B, et al.The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews [J]. BMC Med Res Methodol, 2003, 3(25):1-13
[12]
Dinnes J, Deeks J, Kirby J,et al. A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy [J].Health Technol Asses, 2005, 9(12): 1-113.
[13]
Verhaven E F C, Maryam S, Handelberg F W J, et al. The accuracy of three-dimensional magnetic resonance imaging in the diagnosis of ruptures of the lateral ligaments of the ankle. [J]. Am J Sports Med, 1991, 19(6): 583-587.
[14]
Chandnani V P, Harper M T, Ficke J R, et al. Chronic ankle instability: evaluation with MR arthrography, MR imaging, and stress radiography. [J]. Radiology, 1994, 192(1): 189-194.
[15]
Martin J, Breitenseher S T, Manfred M,et al. MRI versus lateral stress radiography in acute lateral ankle ligament injuries [J]. J Comput Assist Tomogr, 1997, 21(2): 280-285.
[16]
Chou M C, Yeh L R, Chen C K, et al. Comparison of plain MRI and MR arthrography in the evaluation of lateral ligamentous injury of the ankle joint [J]. J Chin Med Assoc, 2006, 69(1): 26-31.
[17]
Kumar V, Triantafyllopoulos I, Panagopoulos A, et al. Deficiencies of MRI in the diagnosis of chronic symptomatic lateral ankle ligament injuries [J].Foot Ankle Surg, 2007, 13(4): 171-176.
[18]
Joshy S, Abdulkadir U, Chaganti S,et al. Accuracy of MRI scan in the diagnosis of ligamentous and chondral pathology in the ankle [J].Foot Ankle Surg, 2010, 16(2): 78-80.
[19]
Oae K, Takao M, Uchio Y,et al. Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging [J]. Skeletal Radiol, 2010, 39(1): 41-47.
[20]
Park H J, Cha S D, Kim S S, et al. Accuracy of MRI findings in chronic lateral ankle ligament injury: comparison with surgical findings [J]. Clin Radiol, 2012, 67(4): 313-318.
[21]
Cho J H, Lee D H, Song H K,et al. Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy [J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1022-1028.
[22]
Park H J, Lee S Y, Park N H,et al. Three-dimensional isotropic T2-weighted fast spin-echo (VISTA) ankle MRI versus two-dimensional fast spin-echo T2-weighted sequences for the evaluation of anterior talofibular ligament injury [J]. Clin Radiol, 2016, 71(4): 349-355.
[23]
Staats K, Sabeti-Aschraf M, Apprich S, et al. Preoperative MRI is helpful but not sufficient to detect associated lesions in patients with chronic ankle instability [J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(7): 2103-2109.
[24]
Tan D W, Teh D J W, Chee Y H. Accuracy of magnetic resonance imaging in diagnosing lateral ankle ligament injuries: a comparative study with surgical findings and timings of scans [J]. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2017, 7:15-20.
2019, Vol. 30 
