Diagnosis and guided interventions in antrolateral compartment of ankle: Ultrasound as first line imaging

Congress:

ECR 2019

Poster Number:

C-1782

Type:

Educational Exhibit

Keywords:

Interventional non-vascular, Musculoskeletal soft tissue, Ultrasound, Diagnostic procedure, Localisation, Athletic injuries

Authors:

M. Kumar¹, D. K. Singh², M. K. Mittal², N. KUMAR², B. K. Nayak³, S. Tomar², S. Suman², A. Katyan³, P. Khanna²; ¹New Delhi, New Delhi/IN, ²New Delhi/IN, ³New Delhi , Delhi/IN

DOI:

10.26044/ecr2019/C-1782

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1782

Fig. 1: Schematic diagram shows anterolateral ankle ligaments which includes Anterior...

Fig. 2: Schematic diagram of anterolateral ankle shows boundaries of anterolateral...

Fig. 16: Ultrasound image shows guided PRP intervention procedure for calcaneofibular...

Learning objectives

To discuss the Ultrasound (US) anatomy of anterolateral ligaments and recess of ankle. To illustrate US appearances of anterolateral ligaments tear and anterolateral impingement (ALI). To describe the role of ultrasound guided interventions in anterolateral ankle.

Background

Ankle joint injuries are common and are usually related to lateral ligament sprain. Approximately 85% of them are due to inversion forces and, therefore, involve the lateral collateral ligamentous complex1. Ankle sprains are frequently encountered in individuals playing football, basketball, and other team sports2,3. These injuries can lead to chronic pain and instability and may delay return to sport activity4 Lateral ankle ligaments are anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), calcaneofibular ligament (CFL), anterior inferior tibiofibular ligament (AITFL) and the posterior inferior tibiofibular...

Findings and procedure details

The patient was examined with a high frequency (14-18MHz) linear transducer in supine position. Hindfoot in maximal inversion & flexion position with plantar surface of the foot lying flat on the table. Ligaments were assessed with differentiation of normal and abnormal echogenicity of ligament and various types of tears. In suspicious cases, comparison with normal appearing contralateral side was done. (Fig 3,4,5,6,7,8) ATFL was the most common ligament to injured. The ATFL tear was graded as follows15: Grade I: Intact ligament ( Fig 9). Grade...

Conclusion

Ultrasound plays an important role in diagnosis of anterolateral ankle instability and in grading of ATFL tears and other ligaments which aids in deciding management strategies. Ultrasound guided injections are precise and allow accurate insertion of needle into target tissues. This helps in delivering the injectant with real time visualization; thus, avoiding unnecessary surgeries.

Personal information

Dr Mahesh Kumar, Senior Resident, Deptt of Radiodiagnosis, VMMC & Safdarjung hospital, New Delhi, India (110029).

References

Margetic P, Salaj M, Lubina IZ. The value of ultrasound in acute ankle injury: comparison with MR. European Journal of Trauma and Emergency Surgery. 2009 Apr 1;35(2):141-6. JD, van Dijk CN. Management of acute lateral ankle ligament injury in the athlete. Knee Surg Sports Traumatol Arthrosc 2013;21(6):1390–1395. McCollum GA, van den Bekerom MP, Kerkhoffs GM, Calder JD, van Dijk CN. Syndesmosis and deltoid ligament injuries in the athlete. Knee Surg Sports Traumatol Arthrosc 2013; 21(6):1328–1337. Maffulli N, Longo UG, Gougoulias N, Caine D, Denaro V....