Anterior Talocrural Joint Laxity: Diagnostic Accuracy of the Anterior Drawer Test of the Ankle.

This prospective, blinded, diagnostic accuracy study with the aim of investigating the diagnostic accuracy of the ankle anterior drawer test (ADT) to detect anterior talocrural joint laxity in adults with a history of lateral ankle sprain. The ADT is used to manually detect anterior talocrural joint laxity following lateral ankle sprain injury; although, the diagnostic accuracy of this test has not been established. Sixty-six individuals with a history of lateral ankle sprain were examined with the ADT. Anterior talocrural joint laxity was measured digitally from ultrasound images of the talofibular interval during performance of the ADT. Anterior talocrural joint laxity was measured digitally in 20 control subjects to establish a reference standard as well. The authors defined ADT results as “positive” or “negative” based on this and a second reference standard established from the literature. The group with a history of lateral ankle sprain had 3.36 (3.25) mm mean (SD) anterior talocrural joint laxity compared with 0.17 (1.87) mm in the control group. Thirty-five of 66 (53%) subjects demonstrated ≥ 2.3 mm of anterior laxity and 24 (36%) at a reference standard of ≥ 3.7 mm of anterior talocrural joint laxity. Sensitivity (95% CI) of the ADT was 0.74 (0.58, 0.86) and 0.83 (0.64, 0.93) at the ≥ 2.3 mm and ≥ 3.7 mm reference standards, respectively. Specificity (95% CI) of the test was 0.38 (0.24, 0.56) and 0.40 (0.27, 0.56), respectively. Positive likelihood ratios were 1.2 and 1.4 while the negative likelihood ratios were 0.66 and 0.41, respectively.

The ADT has some limitations in the detection of excessive anterior talocrural joint laxity, however, it may provide useful information when used in side-to-side ankle comparisons and in addition to other physical exam procedures like palpation.

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Comments

JERRY HESCH

I believe that this is additive to the discussion on the above cited article.
I have a recent case where drawer was negative, very stable…unless I slightly inverted the foot. There are3 videos parts I, II, III. I tried to find reference to false negative and the use of modified drawer, and inversion all key words but came up with nothing. I wonder if some diagnoses are being missed on the basis of anomalous shape of the articulation in which bony stability is significant in neutral overriding a genuine ligament tear.
Part 1: Ankle Instability False Negative Anterior Drawer – Hesch Method of Manual Therapy https://www.youtube.com/watch?v=U9JaKhos2TU
Part 2: Ankle Instability False Negative Anterior Drawer – Hesch Method of Manual Therapy
https://www.youtube.com/watch?v=YKvUFmZK_C4
Part 3: Ankle Instability False Negative Anterior Drawer – Hesch Method of Manual Therapy
https://www.youtube.com/watch?v=EY3rkFmiz7U

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