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We evaluated the value of dynamic stress ultrasonography in differentiating the severity of the lateral collateral ligament of ankle. High-frequency ultrasonography was used to examine the acute injury of the anterior talofibular ligament in 21 patients (15 male, 6 female). The average age of patients was 26 years (range 17 to 36 years). Images were obtained using a 10 MHz scanner, and the anterior talofibular ligaments were inspected in both the neutral and the stretched status. The diagnostic criteria was based on direct visualization of the severity of pathoanatomic changes of the anterior talofibular ligament. Five patients with hematoma, joint capsule swelling and without ligamentous rupture were classified as Grade I injury. Twelve patients with incomplete rupture under the stress ultrasonography was classified as having Grade II injury. In the four patients with Grade III injury, sosographic evidence of complete rupture was confirmed at surgery. The functional assessment at 12months after injury revealed 19 (90%) patients had good results, which verified that patients had mostly received a proper treatment protocol based on correct grading of the injury. These results show that dynamic stress ultrasonography is reliable in determining the severity of injury of the anterior talofibular ligament, and can be used as an adjuvant imaging acute ankle injuries.

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