Functional ultrasonography in the diagnosis of acute anterior cruciate ligament injuries: A field study

Palm, H.-G.; Bergenthal, G.; Ehry, P.; Schwarz, W.; Schmidt, R.; Friemert, B.

doi:10.1016/j.knee.2009.04.012

« Previous Next »The Knee
Volume 16, Issue 6 , Pages 441-446, December 2009

Functional ultrasonography in the diagnosis of acute anterior cruciate ligament injuries: A field study

H.-G. Palm
- Department of Orthopedics and Trauma Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
- Corresponding author. Tel.: +49 731 1710 1915; fax: +49 731 1710 1230.
G. Bergenthal
- Department of Orthopedics and Trauma Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
P. Ehry
- Department of Orthopedics and Trauma Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
W. Schwarz
- Department of Orthopedics and Trauma Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
R. Schmidt
- Department of Visceral and Thoracic Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
B. Friemert
- Department of Orthopedics and Trauma Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany

Received 21 September 2008; received in revised form 29 April 2009; accepted 30 April 2009. published online 25 May 2009.

Abstract

Functional ultrasonography is a rapid and inexpensive method of diagnosing anterior cruciate ligament (ACL) injuries. In previous studies, we assessed the diagnostic accuracy of this innovative method by experienced sonographers. The objective of the present study was to investigate whether an examiner without specialist expertise in arthrosonography can achieve similar positive results and whether this technique is effective as a screening tool that can help reduce the number of undetected ACL injuries.

After a short period of training, a single examiner prospectively measured anterior tibial translation by ultrasonography in the injured and healthy knees of 41 patients with acute knee trauma. An ACL rupture was presumed to be present if the side-to-side difference in tibial translation exceeded 1 mm (ΔD>1 mm). All patients who were enrolled in the study underwent arthroscopy or at least magnetic resonance imaging (MRI).

Ultrasonography revealed the presence of an ACL lesion in 32 of 33 patients with arthroscopically confirmed ACL rupture (sensitivity: 97%, specificity: 87.5%). The mean side-to-side differences (ΔD) between injured (3.8 mm±1.5 mm) and uninjured ACLs (0.1 mm±0.7 mm) were statistically significant (p<0.05).

Our study shows that an examiner without specialist knowledge in ultrasonography can accurately diagnose acute ACL injuries using functional ultrasonography. No additional mechanical tests (KT-1000/KT-2000) or MRI examinations are required. Functional ultrasonography is easy to learn and ensures a high level of diagnostic accuracy. It is well suited for applications in private practices and smaller hospitals with basic medical/surgical care.

Keywords: Functional ultrasonography, Anterior cruciate ligament (ACL), Anterior tibial translation (ATT), Arthroscopy, Magnetic resonance imaging (MRI)