Point-of-care ultrasound for diagnosing tendon and ligament injuries of the wrist and ankle in emergency medicine

Abstract Background Tendon and ligament injuries of the wrist and ankle are among the most frequently reported cases in emergency medicine (EM), requiring prompt and accurate diagnosis. Point-of-care ultrasound (POCUS) has emerged as a crucial and valuable tool for bedside assessment, guiding the interventions to be undertaken by medical practitioners, potentially reducing delays associated with advanced imaging modalities such as MRI. However, the diagnostic accuracy of POCUS in these various injuries remains unclear. Therefore, this review aims to summarize POCUS’s diagnostic accuracy in diagnosing ankle and wrist tendon and ligament injuries. Methods Independent authors conducted a literature search utilizing two complementary strategies to identify all articles published until December 2024. Eligible studies included adults and pediatric patients with suspected tendon or ligament injuries of the wrist and ankle, where POCUS was used as a diagnostic tool and compared with other gold standard references, including magnetic resonance imaging (MRI), computed tomography (CT), and surgical findings. The reported outcomes were then analyzed using STATA version 16, and the results were presented using the forest plots. Results Our electronic search yielded 765 studies, of which six were included. Our pooled analysis found that the overall sensitivity of POCUS in diagnosing tendon and ligament injuries of the ankle was 96.63%, while its specificity was 99.13%. A subgroup analysis according to the type of tendon and ligament injuries revealed that the sensitivity and specificity of POCUS for diagnosing anterior talofibular ligament (ATFL) injuries were 93.32% and 95.72%, respectively. In addition, POCUS detected Achilles tendon rupture, calcaneofibular ligament (CFL) injury, distal anterior tibiofibular ligament (AiTFL) injury, deltoid ligament injury, and posterior talofibular ligament (PTFL) injury with sensitivity of 100%, 96.56%, 100%, 100%, and 50%, respectively, and specificity of 100%, 98.63%, 100%, 95.90%, and 93.10%, respectively. Only two studies reported the accuracy of POCUS in diagnosing tendon and ligament injuries of the wrist. The pooled results revealed that the sensitivity of POCUS in detecting tendon and ligament injuries of the wrist was 85.10%, and the specificity was 99.55%. Conclusion POCUS demonstrated high diagnostic accuracy in selected ankle injuries and moderate accuracy in wrist injuries, though evidence remains limited. This high accuracy and sensitivity in diagnosis favors its implementation as an alternative, rapid diagnostic tool in the emergency department in handling the select cases.