US Ankle US is not typically the next line of evaluation of syndesmotic injuries. Although some studies have suggested focused US could be beneficial for ligamentous evaluation, others have shown limited utility in lateral ankle ligament sprains [75]. Summary of Recommendations Variant 1: Ankle radiographs are usually appropriate for the initial imaging of patients 5 years of age or older with acute trauma to the ankle or acute trauma to the ankle with persistent pain for more than 1 week but less than 3 weeks with no exclusionary criteria present and the OAR are positive: 1. Inability to bear weight immediately after the injury, OR 2. Point tenderness over the medial malleolus, the posterior edge or inferior tip of the lateral malleolus, talus, or calcaneus, OR 3. Inability to ambulate for 4 steps in the emergency department. Variant 2: Imaging is usually not appropriate for patients 5 years of age or older with acute trauma to the ankle when the patient is able to walk and there are no exclusionary criteria present (eg, neurologically intact (including no peripheral neuropathy)) and the OAR are negative: No point tenderness over the malleoli, talus, or calcaneus on physical examination. Variant 3: Ankle radiographs are usually appropriate for the initial imaging of patients 5 years of age or older with acute trauma to the ankle when exclusionary criteria are present (eg, neurologic disorder, neuropathy, or other) and the patient does not meet requirements for evaluation by the OAR. Acute Trauma to the Ankle ankle without IV contrast is more likely to be performed for known fracture evaluation with MRI ankle without IV contrast more likely to be performed for potential osteochondral injury evaluation. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.
Acute Trauma to the Ankle. US Ankle US is not typically the next line of evaluation of syndesmotic injuries. Although some studies have suggested focused US could be beneficial for ligamentous evaluation, others have shown limited utility in lateral ankle ligament sprains [75]. Summary of Recommendations Variant 1: Ankle radiographs are usually appropriate for the initial imaging of patients 5 years of age or older with acute trauma to the ankle or acute trauma to the ankle with persistent pain for more than 1 week but less than 3 weeks with no exclusionary criteria present and the OAR are positive: 1. Inability to bear weight immediately after the injury, OR 2. Point tenderness over the medial malleolus, the posterior edge or inferior tip of the lateral malleolus, talus, or calcaneus, OR 3. Inability to ambulate for 4 steps in the emergency department. Variant 2: Imaging is usually not appropriate for patients 5 years of age or older with acute trauma to the ankle when the patient is able to walk and there are no exclusionary criteria present (eg, neurologically intact (including no peripheral neuropathy)) and the OAR are negative: No point tenderness over the malleoli, talus, or calcaneus on physical examination. Variant 3: Ankle radiographs are usually appropriate for the initial imaging of patients 5 years of age or older with acute trauma to the ankle when exclusionary criteria are present (eg, neurologic disorder, neuropathy, or other) and the patient does not meet requirements for evaluation by the OAR. Acute Trauma to the Ankle ankle without IV contrast is more likely to be performed for known fracture evaluation with MRI ankle without IV contrast more likely to be performed for potential osteochondral injury evaluation. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.