Anterior Drawer Test Ankle | Inversion Trauma | Ankle Sprain

Patients who experienced ankle inversion traumata can be left with talocrural joint laxity. Croy et al. (2013) investigated the Anterior Drawer’s ability to detect laxity when compared to ultrasound imaging. They defined two cut-off points for talocrural joint laxity. The first one was set at 2,3mm or greater in the talofibular interval and the second one at 3,7mm or greater.

Values for sensitivity and specificity were 74% and 38% for the first interval and 83% and 40% for the second interval. So statistically, the anterior drawer’s ability to detect talocrural joint laxity increases with a larger talofibular interval or increased anterior translation during the test. Overall, we attribute the test a weak clinical value.

To conduct the test, the patient lies supine, the upper leg is supported by the table, the knee joint is flexed, and the ankle joint is held in 10-15° of plantarflexion. Then grasp the heel, while the patient’s foot lies on the anterior aspect of your forearm. With the other hand, hold back the patient’s tibia and then draw the foot anteriorly.

In a positive test, you would feel increased anterior translation compared to the unaffected ankle and might be able to observe a dimple appearing on the anterolateral aspect of the talus. Miller et al. (2016) conducted a cadaver study and found that when allowing the talocrural joint to internally rotate around the axis of the intact deltoid ligament, it was able to detect more subtle degrees of ankle instability.

Another common orthopedic test to perform to assess the integrity of the ligaments of the lateral ankle is the Talar Tilt Test.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Croy T, Koppenhaver S, Saliba S, Hertel J. Anterior talocrural joint laxity: diagnostic accuracy of the anterior drawer test of the ankle. journal of orthopaedic & sports physical therapy. 2013 Dec;43(12):911-9.

Van Dijk CN, Mol BW, Lim LS, Marti RK, Bossuyt PM. Diagnosis of ligament rupture of the ankle joint: physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma. Acta Orthopaedica Scandinavica. 1996 Jan 1;67(6):566-70.

Miller, A. G., Myers, S. H., Parks, B. G., & Guyton, G. P. (2016). Anterolateral drawer versus anterior drawer test for ankle instability: a biomechanical model. Foot & ankle international, 37(4), 407-410.