Inter and intra-examiner reliability of musculoskeletal ultrasound scanning of Anterior Talofibular Ligament and ankle muscles

Özgül, Bahar; Starbuck, Chelsea; Polat, Mine Gülden; Abdeen, Rawan; Nester, Christopher

Abstract

Purpose
Although the function of subjects with chronic ankle instability (CAI) has been examined, structural analysis by ultrasound scanning of the structures surrounding the ankle is limited. Before such structural comparisons between injured and uninjured people can be made it is important to investigate a reliable measurement protocol of structures possibly related to CAI. The aim of this study was to investigate the inter-intra examiner reliability of ultrasonic characteristics of selected structures in healthy subjects.

Methods
Eleven healthy participants were assessed by an experienced sonographer and inexperienced certificated examiner. Ultrasound images were collected of the ATFL length and ankle muscles of gastrocnemius medialis (GM), tibialis anterior (TA) and peroneals. Thickness was measured for the muscles, whilst cross-sectional area (CSA) was measured for the peroneals. Inexperienced examiner repeated the measurements a week later.

Results
Inter-examiner reliability was excellent for all structures (ICC3,1 = 0.91–0.98). Intra-examiner reliability shows excellent agreement for all structures (ICC3,1 = 0.92–0.98) except GM (good agreement) (ICC3,1 = 0.82). LoA, relative to structure size, ranged from 1.38 to 6.88% for inter-reliability and from 0.07 to 5.79% for intra-reliability.

Conclusion
This study shows a high level of inter-intra examiner reliability in measuring the structures possibly related to CAI. Future research has been planned to investigate the structural analysis in CAI by using applied MSUS protocol.

• Journal Article Type: Article
• Acceptance Date: Jun 13, 2022
• Online Publication Date: Sep 1, 2022
• Publication Date: 2023-03
• Deposit Date: Jun 2, 2023
• Journal: Journal of Ultrasound
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Pages: 137-146
• DOI: https://doi.org/10.1007/s40477-022-00699-8
• Keywords: Radiology, Nuclear Medicine and imaging; General Medicine; Internal Medicine
• Additional Information: Received: 17 March 2022; Accepted: 13 June 2022; First Online: 1 September 2022; : ; : The researcher Bahar Özgül was financially supported by Scientific and Technological Research Council of Turkey, Directorate of Science Fellowships and Grant Programs [Program Code: 2214-A, Reference Number: 53325897-115.02-243381]. There is no role of sponsor in the study design which comprises of data collection, statistical analysis, and interpretation of data; writing of the manuscript; and the decision to submit the manuscript for publication.; : The authors have no relevant financial or non-financial interests to disclose.; : All authors contributed to the study conception and design. Study design was performed by Bahar Özgül, Mine Gülden Polat and Christopher Nester. Ultrasound scanning protocol was planned and tested by Bahar Özgül and Rawan Abdeen. Data collection was performed by Bahar Özgül and Rawan Abdeen. Data analysis was performed by Bahar Özgül. The first draft of the manuscript was written by Bahar Özgül and Chelsea Starbuck. The first draft and revised drafts of the manuscript were edited by Christopher Nester and Mine Gülden Polat and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.; : This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from the University’s Research Ethics Panel (Reference no: HSR1617-106).; : Written informed consent was obtained from all individual participants included in the study.; : The authors affirm that human research participants provided informed consent for publication of the images in Figs. InternalRef removed–InternalRef removed.