Anterior Drawer of the Ankle

Original Editor - Staci Burns

Lead Editors - Peter Vaes. If you would like to be added as a lead editor on this page please read more.

Top Contributors - Evan Thomas, Rachael Lowe, Peter Vaes, Laura Ritchie and Staci Burns

Purpose

Courtesy of Primal Pictures
The purpose of this test was to determine whether ankle mechanical instability or hypermobility in the sagittal plane of the talocrural joint (or upper ankle joint) is present.







Technique

[1]

The patient is supine, the knee joint is in 20° of flexion, the heel is resting on the palm of the examiner's hand that is resting on the table thereby stabilizing the calcaneus. The examiner pushes the tibia (and fibula) posteriorly observing the amount of posterior translation of the tibia and fibula at the lateral aspect of the ankle and the change in end feel. The amount of posterior translation and the eventual weakening of the end feel, changing from hard ligamentous to weak elastic, is observed. A posterior translation greater than 1 cm compared to the healthy contralateral ankle and an evident weakening of the end feel are most indicative of a partial rupture or complete rupture of the anterior talofibular ligament. The test is graded on a 4-point scale. 0 represents no laxity and 3 represents gross laxity.

Evidence

Anterior drawer has sensitivity of 86 percent and specificity of 74 percent for a diagnostic test of 160 patients with an inversion ankle sprain when compared to an arthrogram (Evidence level 2B).[2]

In a prospective, blinded, diagnostic-accuracy study, Croy et al. measured diagnostic accuracy of the anterior drawer test of the ankle in sixty-six subjects with a history of lateral ankle sprain. Using ultrasound imaging during performance of the anterior drawer test the talofibular interval was measured digitally.[3]

Sensitivity of the the anterior drawer test was 0.74 (95% confidence interval [CI]: 0.58, 0.86) and 0.83 (95% CI: 0.64, 0.93) at the 2.3 mm or greater and 3.7 mm or greater reference standards, respectively. Specificity of the test was 0.38 (95% CI: 0.24, 0.56) and 0.40 (95% CI: 0.27, 0.56), respectively. Positive likelihood ratios were 1.2 and 1.4, whereas the negative likelihood ratios were 0.66 and 0.41, respectively (Evidence level 3B).[3]

Resources

van Dijk et al 1996 Article - Discusses how sensitivity and specificity changes 5 days after injury vs examining within 48 hours.

References

  1. Physiotutors. Anterior Drawer Test of the Ankle | Chronic Ankle Laxity & Anterior Talofibular Ligament Rupture. Available from: https://www.youtube.com/watch?v=vAcBEYZKcto
  2. van Dijk CN, Lim LSL, Bossuyt PMM, Marti RK. Physical Examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg. 1996; 78-B: 958-962.
  3. 3.0 3.1 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; 43(12): 911-9.