PubMed · 8953973
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A Laupacis, I Stiell, D Stewart, A Anis. 1996. Using the Ottawa Ankle Rules.. https://doi.org/10.1016/s0196-0644(96)70102-6
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The demand for minimally invasive techniques and more comfort for the patient is becoming higher and higher. In the region of the ankle joint, it is therefore ideal to use the arthroscope for pathology. Indications for ankle joint arthroscopy are: soft tissue impingement, ligament instability, impingement in the syndesmosis, osteochondral lesions, loose bodies, arthrosis, and loose os trigonum of the talus. In the subtalar joint the indications are rupture of the ligaments, loose bodies, and synovitis with soft tissue impingement. A new indication is arthroscopically assisted arthlodesis of the talar and subtalar joint. The reported high incidence of complications, especially in terms of neurovascular lesions, can be avoided by an exact knowledge of anatomy and use of non-invasive distraction of the joint.
Over an 18-month period findings of stress X-ray of the ankle and medical records of 112 cases were analyzed retrospectively as to indications, results and therapeutic consequences. The analysis showed that critical setting of indications can reduce the frequency of stress X-ray of the ankle and thus lower the total costs. The introduction of guidelines could be advantageous at medical training institutions.
PURPOSE: Determination of the value of 13-MHz high-frequency ultrasound in the diagnosis of acute injuries of the lateral ankle ligaments and the anterior tibiofibular ligament by comparison with MRI. METHOD: Sonography was performed prospectively in 64 acutely injured patients using a mechanical 13-MHz sector probe; for diagnosis of the anterior tibiofibular ligament a 15-MHz sector probe was employed during the course of this trial. Using a 0.2-T unit for MRI examination, T1-weighted (TR 580 ms, TE 24 ms) and T2-weighted (TR 3000 ms, TE 80 ms) spin-echo sequences were obtained in various oblique axial imaging planes. RESULTS: In the differentiation of intact and injured ligaments, ultrasound and MRI agreed in 95.3% of cases for the anterior fibulotalar ligament, in 88.3% for the fibulocalcanear ligament and in 85.0% for the anterior tibiofibular ligament. CONCLUSION: Lesions of the anterior talofibular and fibulocalcanear ligament can be accurately demonstrated by ultrasound if a 13-MHz sector scanner is used. The detection of lesions in the anterior tibiofibular ligament is more difficult. With increasing experience and by using a 15-MHz sector scanner, better results can be expected for this ligament.