Study On The Application Value Of Dynamic Ultrasound In The Preoperative Decision-making Of The Old Injury Of Anterior Talofibular Ligament

Objective To investigate the clinical application and value of dynamic ultrasound in preoperative decision-making of old injury of ankle talofibular ligament(ATFL).MethodsFrom November 2018 to January 2020,56 patients with ankle joint injury who underwent ATFL repair or reconstruction under ankle arthroscopy in our hospital were selected as the study objects,including 35 males and 21 females,19-57 years old with an average age of(33.5 ± 9.1)years,31 left ankle and 25 right ankle.Before operation,the author and the ultrasound doctor cooperated to perform the ATFL dynamic high frequency ultrasound examination of ankle joint in neutral position and stress position(front drawer position,inversion position).The ATFL of ankle joint was examined with high frequency ultrasound probe when the ankle joint was in front drawer position,inversion position(dynamic)and neutral position(static),the results of dynamic ultrasound were recorded and analyzed,and the results were compared with those of magnetic resonance imaging of ankle joint,MRI and intraoperative ankle arthroscopic results(gold standard)were analyzed and compared to explore the application value of dynamic ultrasound and MRI in the selection of preoperative surgical methods(repair or reconstruction)for patients with old ankle ATFL injury.In addition,the sensitivity(Sensitivity,SE),specificity(Specificity,SP),positive predictive value(Positive predictive value,PPV),negative predictive value(Negative predictive value,NPV),accuracy(Accuracy,A)and Yoden index(Yoden index,YDI)of dynamic ultrasound and MRI in the diagnosis of old injury of ankle anterior talofibular ligament were calculated.ResultsArthroscopy showed that 9 patients(2 of them were multiple ligament relaxation),43 patients were treated with ATFL,2 patients were treated with simple exploration and cleaning of ankle,1 patient was treated with micro fracture of talus cartilage,1 patient was treated with elastic fixation of lower tibiofibular joint.With arthroscopy as the gold standard,the accuracy of X-ray diagnosis of stress position under anesthesia was 69.2%.The accuracy of dynamic ultrasound in the diagnosis of ligament injury was 75%,26.7% and 81.1% respectively.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and yoden index were 94.2%,75.0%,98.0%,50.0%,92.9% and 69.2%,respectively.The area under ROC curve was 0.935,and the ability to pre evaluate the operation mode was of clinical significance.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Jordan index of MRI in the diagnosis of old ankle injury were 76.9%,50.0%,95.2%,14.3%,75.0% and 26.9%,respectively.The area under ROC curve was 0.603,and the ability to pre evaluate the operation mode had no clinical significance.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Jordan index of dynamic ultrasound combined with MRI were 94.2%,100.0%,100.0%,57.1%,94.6% and 94.2%respectively.The area under ROC curve is 0.953,so it is of clinical significance to pre evaluate the ability of operation.In addition,compared with MRI,there were significant differences in sensitivity,specificity,negative predictive value and accuracy(P < 0.05),but no significant differences in positive predictive value(P > 0.05).The difference of sensitivity,specificity,negative predictive value and accuracy was statistically significant(P < 0.05),while the difference of positive predictive value was not statistically significant(P > 0.05).There was no significant difference in sensitivity,negative predictive value,accuracy and positive predictive value(P > 0.05).Conclusion1.Dynamic ultrasound is a new and effective method for the diagnosis of old ankle ATFL injury.It has the advantages of easy image acquisition,low cost and short operation time,and it is worthy of clinical promotion;2.Dynamic ultrasound has high sensitivity,specificity and accuracy in the diagnosis of old ankle ATFL injury.Compared with MRI,there are significant differences in sensitivity,specificity,negative predictive value and accuracy.3.Dynamic ultrasound has high clinical application value in the preoperative decision-making of ankle ATFL old injury surgery,which makes a more accurate judgment on the quality of injured ligament,so that clinicians have a more objective evaluation basis when choosing the ATFL repair or reconstruction surgery,and can guide the clinical selection of appropriate surgical treatment scheme of ATFL old injury.