Clinical assessments are valid to grade ligament injury severity compared to ultrasound imaging in patients with acute lateral ankle sprains: a cross-sectional study

To determine accuracy of clinical examination in grading ankle ligament sprain severity, using ultrasound (US) imaging as the reference standard. Design: Cross-sectional study. Setting: Rehabilitation centre. Participants: Sixty-eight athletes with an acute lateral ankle sprain (LAS) (<15 days). Main outcome measures: We performed clinical examinations to grade injury severity: anterior drawer test (ADT), talar tilt test (TTT), palpation and bruising, and patient's perception. Ultrasound imaging (US) was subsequently undertaken as reference standard. We also evaluated combinations of stress tests with palpation and bruising using a believe the negative (BTN) or positive (BTP) approach. We used Cohen's Kappa and Weighted Kappa to analyse agreement between clinical and US grading. Results: ADT and TTT demonstrated moderate agreement with US for grading ATFL (ĸ = 0.547) and CFL injuries (ĸ = 0.507), and Palpation & bruising to grade CFL injury (ĸ = 0.529). Clustering TTT with palpation & bruising increased agreement with BTN approach (ĸ = 0.609). Patients' perception showed slight agreement (ĸ = 0.037) with US. Conclusion: Manual stress tests demonstrate moderate utility for grading grade ATFL and CFL injury severity; combining these tests with palpation (BTN approach) yields higher agreement. US can support more precise grading and should be implemented to enhance ligament injury severity grading after LAS.