Diagnostic tools to evaluate ankle instability caused by a deltoid ligament rupture in patients with supination-external rotation ankle fractures: A systematic review and meta-analysis.

Autor: de Krom MA; Maastricht University Medical Centre+, Dept. of Trauma Surgery, Maastricht, The Netherlands. Electronic address: map.dekrom@student.maastrichtuniversity.nl., Kalmet PH; Maastricht University Medical Centre+, Dept. of Trauma Surgery, Maastricht, The Netherlands., Jagtenberg EM; Maastricht University Medical Centre+, Dept. of Trauma Surgery, Maastricht, The Netherlands., Hermus JP; Maastricht University Medical Centre+, Dept. of Orthopedic Surgery, Maastricht, The Netherlands., van Vugt R; Zuyderland Medical Centre, Dept. of Surgery, Heerlen, The Netherlands., Seelen HA; Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands; Research School CAPHRI, Dept. of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands., Poeze M; Maastricht University Medical Centre+, Dept. of Trauma Surgery, Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: Injury [Injury] 2022 Feb; Vol. 53 (2), pp. 724-731. Date of Electronic Publication: 2021 Sep 23.
DOI: 10.1016/j.injury.2021.09.034
Abstrakt: Aim: Supination-external rotation (SER) ankle fractures account for the majority of ankle fractures and can be divided into stable or unstable fractures, based on the state of the deltoid ligament. The objective of this review was to appraise the available literature concerning diagnostic tools to evaluate deltoid ligament integrity in patients with SER-type ankle fractures.
Methods: A comprehensive literature search of Pubmed and Embase was performed up to December 2020. The outcome measures were sensitivity, specificity and positive and negative predictive value of the diagnostic tools. A meta-analysis was performed to obtain an overview of sensitivity, specificity and area under the curve (AUC). The methodological quality of the articles was evaluated using Quality Assessment of Diagnostic Accuracy Studies.
Results: A total of 12 studies investigating tools for deltoid ligament rupture in patients with SER-type ankle fractures were included. The present study found sensitivity (and specificity) ranges of 0.20-0.90 (and 0.38-0.97) for clinical features, Magnetic Resonance Imaging (MRI) 0.57-0.85 (and 0.81-1.00), ultrasonography 1.00 (and 0.89-1.00), Malleolar Medial Fleck Sign (MMFS) 0.25 (and 0.99), conventional ankle mortise radiography 0.33-0.57 (and 0.60-0.94), gravity stress radiography 0.71-1.00 (and 0.72-0.88) and manual stress ankle radiography 0.65-1.00 (and 0.00-0.77). The largest AUC was found for ultrasonography, followed by MMFS, gravity stress radiography and MRI.
Conclusion: Ultrasonography and gravity stress radiography seem the most accurate diagnostic tools to evaluate deltoid ligament integrity. To strengthen this conclusion, future research should use an identical reference test to ensure comparability of results. Nevertheless, present study is of high value to close the knowledge gap about which presently available diagnostic tool is to be preferred to evaluate deltoid ligament integrity in patients with SER-type ankle fractures.
Competing Interests: Declaration of competing interest None declared.
(Copyright © 2021. Published by Elsevier Ltd.)
Databáze: MEDLINE
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