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.

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South African Journal of Radiology    |    ISSN: 1027-202X (PRINT)    |    ISSN: 2078-6778 (ONLINE)