Ultrasonographic Evaluation of Ankle Instability of Lateral and Medial Ligament Injury in a Cadaver Model

Abstract

Objective:

Diagnosing ankle instability caused by combined lateral and medial ligament injuries is challenging. Although arthroscopy is the standard, ultrasonography offers a less invasive alternative. This study evaluated ankle instability using ultrasonography in a cadaver model.

Materials and Methods:

A cadaver lateral ligament injury model was created by cutting the anterior talofibular ligament (ATFL) under ultrasonography guidance. A bilateral injury model was developed by additionally cutting the tibionavicular ligament (TNL). The ATFL and TNL were identified using bony landmarks, and the linear distance was measured using ultrasonography. Anterior drawer (AD), forefoot abduction, and adduction stresses were applied, and ligament length rates were compared with and without stress.

Results:

In the bilateral injury model, ATFL length increased significantly with AD stress (length rate: 1.170, p = .033), while no significant change was observed in the lateral injury model (length rate: 1.093, p = .68). Tibionavicular ligament length significantly increased with abduction stress in the bilateral injury model (length rate: 1.179, p = .033), while adduction stress had no effect (length rate: 0.864, p = .99).

Conclusion:

Bilateral injuries caused greater anterior instability than lateral injuries. Anterior drawer and abduction stresses are useful for diagnosing these injuries. Ultrasonography could be a practical, non-invasive diagnostic tool for assessing ankle instability.