Morphology of ATFL rupture based on ultrasound imaging
ESSKA Academy. Mioduszewski A. 11/08/19; 284451; epESMA-52 Topic: Anatomy
Dr. Andrzej Mioduszewski
Dr. Andrzej Mioduszewski
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Morphology of ATFL rupture based on ultrasound imaging

ePoster - epESMA-52

Topic: Sports Trauma

Mioduszewski A., Sroczynski J., Mioduszewska A., Kłos G., Wrobel M.
ORTOPEDIKA Specialised Surgery Center, Trauma and Orthopaedics Dept., Warsaw, Poland

Introduction: Ankle sprain is one of the most common injuries in the musculoskeletal system.
It often results in ATFL rupture. Based on examinations and observations of patients, the authors have hypothesised that there are different patterns of tissue damage and that ATFL rupture does not only occur at the fibular part of the ligament. Ultrasound imaging allows precise examination allowing to pinpoint the actual area of the damage.
Objectives: The study was meant to establish different types of ATFL rupture observed on ultrasound images. Proper diagnosis, in turn, could lead to the establishment of guidelines concerning the optimal treatment of each type of ATFL rupture in the future.
Methods: The study was retrospective. The total of 139 patients (admitted in 2017-2018) diagnosed with ankle sprain were included in the study. The ultrasound records were retrieved from the clinic's internal database confirming the the examination was performed in every case.
Based on the ultrasound images the authors have divided ATFL injuries into fibular attachment rupture, talar attachment rupture,and midsubstance tearing. In cases where both attachments were damaged, in some cases, additional avulsion fractures of fibula or talus were observed.
Results: Perifibular injuries were recorded in 93cases (66,91%); out of which a complete ATFL rupture at the fibular attachment was determined in 54 cases (39%), 39 patients (28%) had an avulsion fracture of the fibula. Other types of the rupture were less common, yet still comprised a significant portion of the study group with 28 cases (20%) of the damage to the talar attachment.
Conclusions: The ATFL gets most frequently ruptured at the site of the fibular attachment. Cases combined with the avulsion fracture or resulting in ligament loosening should be recommended for surgical treatment.
Of note, in case of ATFL ruptures there is much room for either incomplete or misdiagnosis when an ultrasound examination is not performed. Thus, ATFL patients require a careful and comprehensive diagnostic process. One of the most frequently missed injuries is the talar attachment tearnig.
In the authors' opinion ultrasound is the best, yet both accessible and affordable, modality allowing to distinguish different types of ATFL injury. Complete diagnosis enables physicians to decide the proper treatment for each case and future studies may result in the creation of rupture-specific methods of intervention, both conservative and surgical.
Morphology of ATFL rupture based on ultrasound imaging

ePoster - epESMA-52

Topic: Sports Trauma

Mioduszewski A., Sroczynski J., Mioduszewska A., Kłos G., Wrobel M.
ORTOPEDIKA Specialised Surgery Center, Trauma and Orthopaedics Dept., Warsaw, Poland

Introduction: Ankle sprain is one of the most common injuries in the musculoskeletal system.
It often results in ATFL rupture. Based on examinations and observations of patients, the authors have hypothesised that there are different patterns of tissue damage and that ATFL rupture does not only occur at the fibular part of the ligament. Ultrasound imaging allows precise examination allowing to pinpoint the actual area of the damage.
Objectives: The study was meant to establish different types of ATFL rupture observed on ultrasound images. Proper diagnosis, in turn, could lead to the establishment of guidelines concerning the optimal treatment of each type of ATFL rupture in the future.
Methods: The study was retrospective. The total of 139 patients (admitted in 2017-2018) diagnosed with ankle sprain were included in the study. The ultrasound records were retrieved from the clinic's internal database confirming the the examination was performed in every case.
Based on the ultrasound images the authors have divided ATFL injuries into fibular attachment rupture, talar attachment rupture,and midsubstance tearing. In cases where both attachments were damaged, in some cases, additional avulsion fractures of fibula or talus were observed.
Results: Perifibular injuries were recorded in 93cases (66,91%); out of which a complete ATFL rupture at the fibular attachment was determined in 54 cases (39%), 39 patients (28%) had an avulsion fracture of the fibula. Other types of the rupture were less common, yet still comprised a significant portion of the study group with 28 cases (20%) of the damage to the talar attachment.
Conclusions: The ATFL gets most frequently ruptured at the site of the fibular attachment. Cases combined with the avulsion fracture or resulting in ligament loosening should be recommended for surgical treatment.
Of note, in case of ATFL ruptures there is much room for either incomplete or misdiagnosis when an ultrasound examination is not performed. Thus, ATFL patients require a careful and comprehensive diagnostic process. One of the most frequently missed injuries is the talar attachment tearnig.
In the authors' opinion ultrasound is the best, yet both accessible and affordable, modality allowing to distinguish different types of ATFL injury. Complete diagnosis enables physicians to decide the proper treatment for each case and future studies may result in the creation of rupture-specific methods of intervention, both conservative and surgical.
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