High-frequency ultrasound examination of acute ankle joint ligament injury and concomitant lesions

Aim : To determine the diagnostic value of high-frequency ultrasonography in the assessment of anterior talofibular ligament (ATFL) injury and concomitant lesions. Methods : We retrospectively analyzed the data of 1005 patients with acute, unilateral ATFL injuries diagnosed using high-frequency ultrasonography in our hospital between January 2021 and December 2024. We analyzed ATFL and calcaneofibular ligament (CFL) thickness in patients with right vs . left ankle injuries and those with complete vs . incomplete ATFL rupture. We also analyzed the damage to other supporting structures of the ankle to provide an imaging basis for clinicians to formulate diagnostic and treatment plans. Results : In patients with incomplete ATFL injury with concomitant CFL injury, the thickness of the left and right CFL was 1.75 ± 0.47 mm and 1.90 ± 0.58 mm, respectively ( P < 0.01). The CFL thickness was 1.83 ± 0.54 mm and 2.13 ± 0.54 mm in patients with incomplete and complete ATFL injury, respectively ( P < 0.001). ATFL injuries were significantly more likely to be associated with concomitant injuries of the CFL and superior extensor retinaculum (SER) than with injuries of other ankle ligaments ( P < 0.05). Conclusion : High-frequency ultrasonography is valuable for diagnosing acute ankle ligament injuries. Complete ATFL rupture can lead to CFL thickening, which often occurs on the right side due to right-sided dominance. ATFL injuries are frequently associated with concomitant CFL and SER injuries, and these structures should be carefully assessed during ultrasound examinations of acute ankle injuries.