Clinical utility of shear wave elastography in diagnosis and prognostic assessment of acute anterior talofibular ligament injuries

Background To investigate the clinical utility of shear wave elastography (SWE) in the diagnosis and prognostic evaluation of acute anterior talofibular ligament (ATFL) injuries. Methods This prospective cohort study enrolled 46 patients with unilateral acute ATFL injuries and 32 age and gender-matched healthy volunteers. All patients underwent B-mode ultrasonography and SWE within 48 h post-injury and at 3 month post-rehabilitation. Quantitative assessments included ATFL thickness, Young’s modulus, shear wave velocity (SWV), vascular perfusion, and echotextural characteristics. Results During the acute phase (≤48 h), injured ATFLs exhibited significantly greater thickness compared to contralateral and healthy control ligaments (3.54 ± 0.68 mm vs 2.15 ± 0.22 mm and 2.31 ± 0.16 mm, respectively; p < .05), alongside markedly reduced Young’s modulus and SWV. Biomechanical parameters were consistently elevated in plantarflexion-inversion versus neutral positioning. At 3-month follow-up, elastic parameters normalized substantially, with restoration of ligamentous thickness and vascular perfusion eliminating intergroup differences. The dynamic trajectory of SWE metrics paralleled structural recovery patterns. Conclusion SWE quantitatively evaluates biomechanical integrity and recovery progression in acute ATFL injuries. Combined with B-mode ultrasonography, SWE provides a robust imaging framework for diagnosis, longitudinal monitoring, and prognostic stratification, demonstrating significant clinical value in musculoskeletal trauma management.