Posterior Drawer Test of the Ankle

Posterior Drawer Test of the Ankle is used to test for posterior talofibular ligament injury and/or ligamentous instability…
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 Posterior Drawer Test of the Ankle

What is Posterior Drawer Test of the Ankle?

  • Posterior Drawer Test of the Ankle is used to test for posterior talofibular ligament injury and/or ligamentous instability of the ankle.

How it's Performed?

  • The patient lies supine with the knee slightly flexed to neutralize the pull of the gastrocnemius muscle.
  • With the ankle joint held at 10 to 15° of plantar flexion, the examiner grasps around the heel with one hand and stabilizes the tibia from the anterior side with the other.
  • After asking the patient to relax the muscles, the examiner moves the foot posteriorly at the ankle
    joint while continuing to hold the tibia with the other hand.

What does a positive Posterior Drawer Test of the Ankle mean?

  • Posterior drawer test of the ankle is positive if the talus moves posteriorly and rotates medially, which means there is an injury to the posterior talofibular or calcaneofibular ligaments.

Notes

Lateral ankle ligaments Anatomy:

They function as a restraint to varus / inversion forces at ankle:

  1. Anterior talofibular ligament (ATFL):
    • Originates from anteroinferior aspect of lateral malleolus (1 cm proximal to its tip) and extends to lateral aspect of talar neck.
    • Physical exam: anterior drawer test of the ankle in 20° of plantar flexion.
    • Its Injury causes low ankle sprains.
  2. Calcaneofibular ligament (CFL):
    • Extends from tip of lateral malleolus to lateral aspect of calcaneus.
    • Physical exam: inversion (supination) test and talar tilt test.
    • Its injury is rare (low ankle sprain).
  3. Posterior talofibular ligament (PTFL):
    • Extends from posterior lateral malleolus to posterolateral talus.
    • Physical exam: posterior drawer test of the ankle.
  4. Lateral Talocalcaneal Ligament (LTCL):
    • It’s a short narrow ligamentous band that connects the lateral process of the talus to the lateral surface of the calcaneus.
    • Located anterior and medial to calcaneofibular ligament.
    • Its function is to stabilize the talocalcaneal joint.
  • ATFL is the weakest ankle ligament.
  • PTFL is the strongest ankle ligament.

Reference

  • Research Gate
  • Millers Review of Orthopaedics -7E Book
  • Clinical Tests for the Musculoskeletal 3rd Ed. Book

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