No Difference in Ligament Discontinuity Versus Thickening on Magnetic Resonance Imaging When Evaluating Anterior Talofibular Ligament Injuries: A Systematic Review
Purpose To systematically review the literature evaluating whether incorporating ligament thickening and increased signal intensity alongside ligament discontinuity on magnetic resonance imaging (MRI) improves diagnostic accuracy for anterior talofibular ligament (ATFL) injuries. Methods Two independent reviewers conducted a systematic literature search on the basis of Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the MEDLINE, Embase, CINAHL Complete, and Scopus databases to find studies reporting MRI and ultrasound imaging findings after ATFL injuries. Statistical analyses were conducted via Review Manager, and a P value of <.05 was statistically significant. Results In total, 15 studies met inclusion criteria, and 9 provided sufficient data for meta-analyses. MRI demonstrated high sensitivity and specificity for diagnosing ATFL injuries. There were greater diagnostic results for ligament thickening with increased signal intensity, but there was no statistically significant difference between diagnostic approaches on the basis solely of ligament discontinuity and the thickening with increased signal intensity. Pooled sensitivity ranged from 84.7% to 87.1%, whereas specificity ranged from 84.6% to 91.4%. Diagnostic odds ratios were consistently high across methods. Conclusions This study found that incorporating ligament thickening and increased signal intensity alongside ligament discontinuity on MRI does not significantly improve diagnostic accuracy. Level of Evidence Level III, systematic review of Level II and III studies.
