High-frequency ultrasound examination of acute ankle joint ligament injury and concomitant lesions

To determine the diagnostic value of high-frequency ultrasonography in the assessment of anterior talofibular ligament (ATFL) injury and concomitant lesions.

We retrospectively analyzed the data of 1005 patients with acute, unilateral ATFL injuries diagnosed using high-frequency ultrasonography in our hospital between January 2021 and December 2024. We analyzed ATFL and calcaneofibular ligament (CFL) thickness in patients with right vs. left ankle injuries and those with complete vs. incomplete ATFL rupture. We also analyzed the damage to other supporting structures of the ankle to provide an imaging basis for clinical diagnosis and treatment.

In patients with incomplete ATFL injury with concomitant CFL injury, the thickness of the left and right CFL was 1.75 ± 0.47 mm and 1.90 ± 0.58 mm, respectively (P < 0.01). The CFL thickness was 1.83 ± 0.54 mm and 2.13 ± 0.54 mm in patients with incomplete and complete ATFL injury, respectively (P < 0.001). The incidence of concomitant CFL and superior extensor retinaculum (SER) injuries significantly differed between patients with incomplete and complete ATFL rupture (P < 0.05).

High-frequency ultrasonography is valuable for diagnosing acute ankle ligament injuries. CFL thickness was greater in patients with complete ATFL injury than in patients with incomplete ATFL injury. A trend toward increase CFL thickness on the right was noted, possibly due to right-sided dominance, though this requires further validation. ATFL injuries are frequently associated with concomitant CFL and SER injuries, and these structures should be carefully assessed during ultrasound examinations of acute ankle injuries.