Diagnostic Performance of Ultrasonography for Detection of Acute Injuries of Lateral Ankle Ligaments: A Systematic Review and Meta-analysis

Introduction: Several studies have assessed the diagnostic accuracy of ultrasonography for detecting acute lateral ankle ligament injuries, but their findings have been inconsistent. This systematic review and meta-analysis investigated the pooled diagnostic performance of ultrasonography for early detection of acute injuries of the four lateral ankle ligaments. Methods: Major databases with a high likelihood of containing eligible studies, including Medline, Scopus, and Web of Science, were systematically searched from inception to April 2026. Diagnostic parameters were estimated using the extracted contingency table data, with MetaDisc software and the MIDAS package in Stata. Results: 10 eligible studies, with a total of 454 patients, were included in the analyses. The sensitivity of ultrasonography for diagnosing injuries of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), posterior talofibular ligament (PTFL), and anterior inferior tibiofibular ligament (AITFL) were 0.95 (95% CI, 0.92–0.98), 0.82 (95% CI, 0.76–0.88), 0.33 (95% CI, 0.13–0.59), and 0.90 (95% CI, 0.74–0.98), respectively. The specificity for detecting injuries of the ATFL, CFL, PTFL, and AITFL was 0.91 (95% CI, 0.85–0.96), 0.90 (95% CI, 0.85–0.95), 0.96 (95% CI, 0.90–0.99), and 0.86 (95% CI, 0.78–0.92), respectively. Conclusion: Ultrasonography demonstrates high diagnostic accuracy for detecting lateral ankle ligament injuries, particularly for the ATFL and AITFL, with strong sensitivity and specificity. It is also effective for both confirming and excluding ATFL injuries. For CFL injuries, ultrasonography shows good diagnostic performance, although it is more effective for confirming than excluding CFL pathology. In contrast, its low sensitivity for PTFL injuries limits its diagnostic reliability for this ligament.