Anterior Drawer Test of the ankle

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 Anterior Drawer Test of the ankle


What is Anterior Drawer Test of the ankle?

Anterior Drawer Test of the ankle is performed to estimate the stability of the anterior talofibular ligament (ATFL).

See Also: Ankle and Foot Anatomy

How do you perform an anterior drawer test of the ankle?

See Also: Posterior Drawer Test of the ankle

What does a positive Anterior Drawer Test of the ankle mean?

Ankle Anterior Drawer Test Accuracy

A Prospective, blinded, diagnostic-accuracy study 1 by Theodore Croy to investigate the accuracy of the anterior drawer test of the ankle in patients with lateral ankle sprain, he found that the ankle anterior drawer test provides limited ability to detect excessive anterior talofibular ligament (ATFL) injury, the sensitivity and specificity was as following:

However, it may provide useful information when used in side-to-side ankle comparisons and in conjunction with other physical exam procedures, such as palpation.

The ATFL can be palpated two to three finger-breadths anteroinferior to the lateral malleolus. This is usually the area of most extreme tenderness following an inversion sprain. The anterior aspect of the distal tibiofibular syndesmosis may also be tender following this type of sprain.

Van Dijk et al. 2 reported that when the combination of pain on lateral ligament palpation, hematoma formation of the lateral ankle, and a positive anterior drawer test were used a lateral ligament lesion was correctly diagnosed in 95% of cases.

Notes

Related Anatomy

Anterior Talofibular Ligament:

References

  1. Croy T, Koppenhaver S, Saliba S, Hertel J. Anterior talocrural joint laxity: diagnostic accuracy of the anterior drawer test of the ankle. J Orthop Sports Phys Ther. 2013 Dec;43(12):911-9. doi: 10.2519/jospt.2013.4679. Epub 2013 Oct 30. PMID: 24175608.
  2. van Dijk CN, Lim LS, Bossuyt PM, Marti RK. Physical examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg Br. 1996 Nov;78(6):958-62. doi: 10.1302/0301-620x78b6.1283. PMID: 8951015.
  3. Landeros O, Frost HM, Higgins CC. Post-traumatic anterior ankle instability. Clin Orthop Relat Res. 1968 Jan-Feb;56:169-78. PMID: 5652775.
  4. Colville MR, Marder RA, Boyle JJ, et al: Strain measurement in lateral ankle ligaments. Am J Sports Med 18:196–200, 1990
  5. Landeros O, Frost HM, Higgins CC: Anteriorly unstable ankle due to trauma: A report of 29 cases. J Bone Joint Surg 48A:1028, 1966.
  6. TohyamaH, Beynnon BD, Renstrom PA, et al: Biomechanical analysis of the ankle anterior drawer test for anterior talofibular ligament injuries. J Orthop Res Official Publ Orthop Res Soc 13:609–614, 1995.
  7. Frost HM, Hanson CA: Technique for testing the drawer sign in the ankle. Clin Orthop 123:49–51, 1977.
  8. Clinical Tests for the Musculoskeletal System 3rd Edition.
  9. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.



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