Aim: to evaluate the diagnostic value of ultrasonography of the ankle in evaluation of ankle 
sprain-related ligamentous injuries. Methods: Fifty patients suffered from sprain-related ankle 
pain, underwent ankle ultrasonography using Xario-200 Toshiba machine with multi-frequency 
linear array transducer (selected frequency 12 MHz), then CT arthrography after ultrasonographic 
guided contrast injection. The sonographic evaluation of the ankle was targeted to lateral 
collateral, syndesmotic and deltoid ligaments. Results: The ultrasonography detected 38 injured 
ligaments in 28 cases; the most common affected ligament was ATFL(21), then the deltoid 
ligament(11), then CFL (6). Ultrasonography showed different positive and negative rates with 
subsequent different sensitivities in diagnosing ankle ligamentous tear when compared with CT 
arthrography as a stranded of reference method, the ATFL and DD had 100% specificity with 
very high accuracy 90% and 94% respectively. Beside ligamentous injury detection, ankle 
effusion and synovial thickening were frequently observed on ultrasonography. Conclusion: 
Ultrasonography is an accurate method for detection of anterior talo-fibular ligament and deep 
deltoid ligament tears.