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Three Part Question

In [patient with possible anterior cruciate ligament injuries] does [ultrasonography] have [adequate diagnostic accuracy]

Clinical Scenario

A 26-year-old male athlete presents to emergency department with a knee injury during playing basketball 4 hours ago. According to history and physical examination, anterior cruciate ligment tear is suspected with knee instability. You wonder whether an ultrasound scan is helpful in the diagnosis of anterior cruciate ligment rupture.

Search Strategy

Medline 1950 to May Week 2 2018. Using the OVID interface [exp Ultrasonography/or ultrasonography.mp. OR ultrasound.mp. OR sonography.mp.] AND [Anterior Cruciate Ligament.mp. or exp Anterior Cruciate Ligament/]
Limit to English language and Human.

Search Outcome

Fifty-three papers were found, of which forty-eight were irrelevant or of insufficient quality for inclusion. The five remaining papers are shown in table 1.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Palm et al. 2009 Germany	Fifty patients with knee injuries were candidates for the study. Anterior tibial translation was measured by ultrasonography. All patients who were enrolled in the study underwent arthroscopy or at least magnetic resonance imaging (MRI).	Single center, prospective study.	Ultrasonography achieves great evaluability of the anterior cruciate ligament rupture.	The sensitivity and specificity for anterior cruciate ligament rupture via sonography were 97% and 87.5%. The positive predictive value (PPV) and negative predictive value (NPV) were 97% and 87.5%.

Comment(s)

The results of these studies need to be viewed with caution. Several methods were proposed to detect anterior cruciate ligment rupture. Suzuki et al. claimed that the anterior cruciate ligment could be visualized by direct ultrasound scanning. However, the results were casuistic and the flexed knee flex position was not applicable to patients with knee hemarthrosis. Other indirect methods include sonographic hematoma sign at the lateral wall of intercondylar notch , anterior measurement of ventral translation of tibial head, and posterior measurement of tibial head ventral translation. All indirect methods were clearly defined and revealed a good diagnostic accuracy.

Clinical Bottom Line

Ultrasound examination is a quick, inexpensive, noninvasive tool in the diagnosis of anterior cruciate ligment rupture with good accuracy.

References

1. Palm HG, Bergenthal G, Ehry P, Schwarz W, Schmidt R, Friemert B. Functional ultrasonography in the diagnosis of acute anterior cruciate ligament injuries: a field study.