Background This study aims to comparatively evaluate the diagnostic performance of high-frequency ultrasound (HFUS) and magnetic resonance imaging (MRI) in the assessment of anterior talofibular ligament (ATFL) injuries, particularly in the context of associated concomitant injuries. By analyzing sensitivity, specificity, accuracy, and inter-modality agreement, we seek to determine the relative clinical utility of these two imaging modalities for comprehensive evaluation of lateral ankle instability and multi-structure involvement. Methods A retrospective, single-center study was conducted on clinical data from 123 surgically treated patients suspected of ATFL ankle injuries who presented to our hospital between May 2015 and June 2025. All patients underwent both HFUS and MRI examinations prior to surgery. Surgical findings were used as the reference standard to compare the diagnostic performance of HFUS and MRI in assessing the severity of acute ATFL injuries. The diagnostic efficacy of HFUS and MRI for ATFL injuries was evaluated using receiver operating characteristic (ROC) curve analysis. Results In grading ATFL injuries, HFUS demonstrated significantly higher diagnostic accuracy compared to MRI (90.24% vs. 78.05%, p < 0.01). The AUC for detecting complete ATFL tears was also markedly superior for HFUS (0.938, 95% CI: 0.898–0.975) compared to MRI (0.857, 95% CI: 0.792–0.917). However, in detecting concomitant calcaneofibular ligament (CFL) injuries, MRI demonstrated substantially higher sensitivity (95.83%, 95% CI: 91.67–99.00) than HFUS (63.54%, 95% CI: 53.69–72.00), highlighting its superior performance in identifying combined ATFL-CFL injuries. Conclusion HFUS demonstrates better diagnostic performance for preoperative grading of ATFL tear severity, whereas MRI shows moderate diagnostic capability in detecting concomitant CFL injuries in the setting of combined lateral ankle ligament trauma. These findings support a complementary imaging strategy, with HFUS as a useful initial tool for ATFL assessment and MRI reserved for comprehensive evaluation when concomitant CFL or other pathologies are suspected.
Binbin Tang, Lei Wang, Yuanjun Zheng et al.· Frontiers in Surgery· 0 citations
PURPOSE
To compare the agreement and the differences between the modified Thoracolumbar Injury Classification and Severity Score (mTLICS) system and the AO Thoracolumbar Spine Injury Score (TL AOSIS) in guiding surgical decision-making for thoracolumbar fractures.
METHODS
The clinical and imaging data of 100 patients with thoracolumbar fractures admitted to our hospital between January 2021 and December 2023 were retrospectively analyzed. Two orthopedic surgeons, blinded to the patients' clinical outcomes, independently evaluated the cases using both scoring systems and provided treatment recommendations. Disagreements were resolved by a senior attending surgeon. Agreement between the two systems' treatment categories was quantified by weighted Cohen's κ with 95% confidence intervals from paired 3 × 3 cross-tabulations, and interobserver reliability was assessed before consensus adjudication.
RESULTS
The two systems assigned the same treatment category in 86 of 100 patients (86.0%; unweighted κ = 0.773, 95% CI 0.666-0.881; linear-weighted κ = 0.820), with no significant asymmetry (McNemar-Bowker P = 0.160). Agreement was substantial in both the 57 neurologically intact patients (κ = 0.696) and the 43 patients with neurological impairment (κ = 0.619). Surgery was recommended by mTLICS versus TL AOSIS in 24.6% versus 19.2% of neurologically intact patients and in 90.7% versus 81.4% of those with neurological impairment. Interobserver reliability before consensus was substantial to high (linear-weighted κ = 0.88 for mTLICS and 0.75 for TL AOSIS). The two scoring systems showed substantial agreement in treatment recommendations. In burst fractures with intervertebral disc injury, mTLICS tended to assign cases to higher treatment categories than TL AOSIS, although these subgroup differences were not statistically significant.
CONCLUSION
mTLICS and TL AOSIS show substantial concordance as decision-support tools for thoracolumbar fractures. For burst fractures with intervertebral disc involvement, mTLICS tends to recommend surgery more often, reflecting a difference in classification behaviour rather than a demonstrated clinical advantage. Because no outcome data were analysed, whether this tendency improves patient outcomes remains to be determined.
Han Zhang, Junwei Feng, Huibin Luo et al.· BMC Surgery· 0 citations