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Table 2 Summary of included studies

From: Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis

Study (author and year) Subject features Age Gender Time from injury to study commencement/duration when patients presented with symptoms Study design Level of evidence Index tests Gold standard Main conclusion
Cha et el. 2012 65 patients diagnosed with chronic lateral ankle instability who received preoperative MRI and arthroscopic examination Not mentioned 39 men and 26 women Not mentioned Case-control study 3b MRI Arthroscopic findings “However, inter-observer reliability and sensitivity of MRI findings were found to be relatively low in this study. Therefore, arthroscopic examination before ligament repair is a useful and recommended method for diagnosis and treatment of intra-articular lesions.”
Chandnani et al. 1994 17 chronic ankle instability patients 24.5 years (ranged from 20 to 48 years) 14 men and 3 women Presented with symptoms of at least 6-months duration and did not respond to conservative therapy that included immobilization and early aggressive rehabilitation Cohort study 2b Stress radiograph, MRI and MR arthrography Findings from either diagnostic arthroscopy (n = 3) or open surgical repair (n = 14) “In conclusion, our results suggest that MR arthrography may be a sensitive technique for detecting and staging tears of the lateral collateral ligaments and evaluating associated injuries in patients with chronic ankle instability. In patients for whom surgery is contemplated, MR arthrography may be a useful adjunct to conventional imaging techniques.”
Cheng et al. 2014 120 patients with a clinical suspicion of chronic ankle ligament injury 32 years (ranged from 15 to 70 years) 85 men and 35 women Duration of symptoms ranged from 6 weeks to 20 years (mean, 2.2 years) Cohort study 2b Ultrasonography Arthroscopic findings (42 of these patients also underwent open surgery) “In conclusion, ultrasonography as a convenient technique with low costs and real-time examination showed a satisfactory sensitivity and specificity for detecting lateral ligament injury.”
Cho et al. 2016 28 consecutive lateral ankle instability patients who underwent ankle arthroscopy 32.4 ± 11.9 years (ranged from 15 to 55 years) 19 men and 9 women Conservative treatment had failed to substantially alleviate the symptoms for at least 3 months Case-control study 3b MRI, manual anterior drawer test, stress ultrasonography, and stress X-ray Arthroscopic findings “Manual stress US is as precise as MRI in the detection of ligament injury and provides information on chronic ankle instability.”
Chou et al. 2006 50 patients suffering from ankle instability (17 of them who would receive surgical intervention were included in this review.) Ranged from 14 to 77 years, n = 50 29 men and 21 women, n = 50 Not mentioned Cohort study 2b MRI and MR arthrography Surgical findings “For evaluating ankle disability, using plain MRI alone is not adequate for correctly detecting lateral collateral ligamentous injury of the ankle joint. MR arthrography improves the sensitivity and the accuracy for ATaF and CF ligament injuries. It also helps in assessing coexisting pathologic lesions of ankle joints.”
Hua et al. 2012 83 consecutive patients underwent ankle arthroscopy for different diagnosis 32.2 years (ranged from 17 to 57 years) 51 men and 32 women Not mentioned Case-control study 3b Ultrasonography Arthroscopic findings “US examination is a reliable and accurate method to evaluate chronic ATFL injury.”
Joshy et al. 2010 24 patients underwent arthroscopy as well as MRI for chronic ankle pain and/or instability 39 years (range from 11 to 65 years) 12 men and 12 women Not mentioned Case-control study 3b MRI Arthroscopic findings “MRI scan has very high specificity and positive predictive value in diagnosing tears of ATFT, CFL and osteochondral lesions. However sensitivity and negative predictive value is low with MRI.”
Kim et al. 2015 79 patients who would undergo ankle arthroscopy for different diagnosis. 34.6 years (ranged from 21 to 67 years) 44 men and 35 women Mean duration of symptoms was 25.9 weeks (range, 11 to 52 weeks) Cohort study 2b MRI Arthroscopic findings “The specificity and positive predictive value of MRI in the diagnosis of ATFL injuries were very high, whereas the sensitivity and negative predictive value of MRI were relatively low.”
Kumar et al. 2007 58 patients with symptomatic instability of their ankle 28 years (ranged from 18 to 50 years) 47 men and 11 women Unresponsive to physiotherapy and non-operative management for at least 6 months Cohort study 2b MRI and stress radiography Arthroscopic findings “MRI did not demonstrate any distinct advantage over the examination under anesthesia and stress radiography in the diagnosis of grade III lateral ankle ligament injuries.”
Lee et al. 2012 34 patients who underwent ankle MRI because of ankle sprains or ankle instability 29 years (ranged from 13 to 53 years) 22 men and 12 women Not mentioned Cohort study 2b MRI Arthroscopic findings “|A cortical defect with a bright dot-like or curvilinear high-signal-intensity lesion on T2-weighted MRI may be regarded as an additional finding to help increase the diagnostic performance for detecting anterior talofibular ligament injuries, including partial tears.”
Oae et al. 2010 34 consecutive patients needed an operation because of severe problems such as osteochondral lesions, synovitis and instability (15 chronic cases of them were included in this review.) 29 years (ranged from 13 to 55 years), n = 34 19 men and 15 women, n = 34 With a history of ankle injury of more than 4 weeks Cohort study 2b Stress radiography, ultrasonography, and MRI Arthroscopic findings “We obtained satisfactory results with US and MR imaging.”
Park et al. 2012 48 people suspected of chronic ankle ligament injury 36 years (ranged from 19 to 64 years) 25 men and 23 women The duration of symptoms ranging from several months to several years Cohort study 2b MRI Surgical findings “In conclusion, MRI does not show perfect sensitivity for the evaluation of chronic lateral ankle ligament injury, such as those to the ATFL and CFL. Diagnosis of a complete tear of the ATFL on MRI is more sensitive than the diagnosis of a complete tear of the CFL. MRI findings of CFL injury were diagnostically specific but were not sensitive.”
Staats et al. 2017 30 patients with CAI and failed conservative treatment 39.1 years (ranged from 18 to 71 years) 15 men and 15 women Not mentioned Cohort study 2b MRI Arthroscopic findings “MRI is a helpful tool for preoperative evaluation, but arthroscopy remains gold standard in the diagnosis of associated lesions in patients with CAI”
Sugimoto et al. 2002 37 ft of 35 patients in whom recurrent instability of the ankle was diagnosed 29.1 years (ranged from 11 to 56 years) 16 men and 19 women Mean interval between the injury and arthrography was 4 years 3 months (range, 6 months–22 years) Cohort study 2b Subtalar arthrography, manual anterior drawer test and talar tilt test Surgical findings “Subtalar arthrography is valuable in making the diagnosis of calcaneofibular ligament injury in recurrent instability of the ankle.”
Tan et al. 2017 82 patients with ankle inversion trauma history (42 in the chronic group were included in this review.) 24.8 years (ranged from 17 to 48 years), n = 42 36 men and 6 women, n = 42 Interval from time of injury to time of MRI more than 3 months Cohort study 2b MRI Surgical findings “MRI was able to accurately diagnose lateral ankle ligament tears in most cases. Diagnosis of a complete ATFL tear on MRI is more sensitive than that of complete CFL tear. The MRI findings of CFL injury were diagnostically specific but were not sensitive.”