Abstract
<title>Abstract</title> <p>Background: Syndesmotic (high ankle) sprains are less common than lateral ankle injuries but can cause prolonged disability if missed. Point-of-care ultrasound (POCUS) has emerged as a rapid bedside tool, yet its diagnostic accuracy for syndesmotic injuries has not been systematically evaluated. Objective: To assess the diagnostic performance of POCUS for detecting syndesmotic ankle injuries in adults, using magnetic resonance imaging (MRI) or arthroscopy or surgical findings as the reference standard. Methods: A systematic review and diagnostic test accuracy meta-analysis was conducted following PRISMA-DTA guidelines. Databases including PubMed, Embase, Scopus, and Cochrane CENTRAL were searched. Studies reporting 2×2 diagnostic data were included. Two independent reviewers performed study selection, data extraction, and quality assessment using the QUADAS-2 tool. A bivariate random-effects model was used to pool sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR−). Summary receiver operating characteristic (SROC) curves and hierarchical SROC (HSROC) models were generated. Subgroup analyses were performed based on injury type (isolated sprain vs fracture-associated). Clinical utility was assessed using Fagan’s nomogram (PROSPERO CRD420261362857). Results: Six studies including 295 examinations were analyzed. POCUS showed a pooled sensitivity of 0.94 (95% CI: 0.87–0.98) and specificity of 0.94 (95% CI: 0.89–0.97). The positive likelihood ratio was 16.30 and the negative likelihood ratio was 0.06, indicating strong diagnostic performance. Subgroup analysis showed higher specificity in isolated injuries compared to fracture-associated cases, while sensitivity remained consistently high. At a pre-test probability of 30%, post-test probability increased to 87.5% after a positive test and decreased to 2.5% after a negative test. Conclusion: POCUS is a highly sensitive and clinically useful diagnostic tool for syndesmotic ankle injuries. Its diagnostic performance is robust, particularly in isolated injuries, and it provides meaningful clinical decision support through significant changes in post-test probability. –</p>