Original Research

Dynamic ultrasound evaluation of the syndesmosis ligamentous complex and clear space in acute ankle injury, compared to magnetic resonance imaging and surgical findings

Chantelle van Niekerk, Barbara van Dyk
South African Journal of Radiology | Vol 21, No 1 | a1191 | DOI: https://doi.org/10.4102/sajr.v21i1.1191 | © 2017 Chantelle van Niekerk, Barbara van Dyk | This work is licensed under CC Attribution 4.0
Submitted: 28 February 2017 | Published: 29 September 2017

About the author(s)

Chantelle van Niekerk, Department of Medical Imaging and Radiation Sciences, University of Johannesburg, South Africa
Barbara van Dyk, Department of Medical Imaging and Radiation Sciences, University of Johannesburg, South Africa


Background: Syndesmosis injuries are often more serious than an injury to the lateral ligament complex of the ankle, with double the recovery time, chronic discomfort and joint instability. Although magnetic resonance imaging (MRI) is considered as the best imaging modality to assess the integrity of the syndesmotic ligamentous complex and clear space, a dynamic ultrasound evaluation may provide an alternative imaging option worthy of exploring.

Aim: The aim of this article is to compare the sensitivity and specificity of musculoskeletal ultrasound and MRI, in the diagnosis of syndesmosis pathology, with surgical findings as the reference point.

Method: MRI was performed on 114 participants presenting with pain over the lateral aspect of the ankle after injury. This was followed by a dynamic ultrasound examination during which the anterior tibiofibular ligament (ATiFL) was assessed for continuity, contour and haematoma. The tibiofibular clear space was measured with the ankle in a neutral position, followed by internal and external rotation.

Results: The Fisher’s exact test was used to determine non-random associations between variables and compute statistical significance (p < 0.05). Ultrasound achieved a sensitivity of 86.3%, specificity of 97% with a false-positive rate of 3%. The sensitivity of MRI is similar to that of ultrasound (86%) with a specificity of 100%.

Conclusion: Although both imaging tests performed very well, MRI was slightly better at excluding pathology while both tests performed equally in demonstrating pathology. As a simple, inexpensive and reproducible test, dynamic ultrasound can thus be considered as an alternative to MRI in acute ankle pathology.


acute ankle injury; syndesmotic clear space measurement; MSK ultrasound


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Crossref Citations

1. MRI of the distal tibiofibular joint
Ban Sharif, Matthew Welck, Asif Saifuddin
Skeletal Radiology  vol: 49  issue: 1  first page: 1  year: 2020  
doi: 10.1007/s00256-019-03260-7