Radiological Assessment of a Modified Anterior Drawer Test of the Ankle

Foot & Ankle ◽  
1992 ◽  
Vol 13 (7) ◽  
pp. 400-403 ◽  
Author(s):  
M. Nyska ◽  
H. Amir ◽  
A. Porath ◽  
S. Dekel
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Common Complication ◽  
Anterior Drawer ◽  
Lateral Tilt ◽  
Anterior Drawer Test ◽  
Significant Movement ◽  
Recurrent Ankle Sprain ◽  
Radiological Examinations

Chronic ankle instability is a common complication of ankle sprain. The clinical assessment of ankle instability is usually incomplete and difficult to interpret. Recently, more attention has been paid to the value of the anterior drawer test of the ankle. We assessed the accuracy of a modification of the anterior drawer test, comparing it with radiological stress view of the ankle in 25 patients with recurrent ankle sprain. The radiological examinations were performed by a TELOS instrument and included lateral and anteroposterior stress views. We found that the modified anterior drawer test correlated with the posterior opening of the tibiotalar joint and with the lateral tilt of the talus. We conclude that a slightly positive modified anterior drawer test may indicate injury to the anterior talofibular ligament. A significant movement of the ankle elicited by the modified anterior drawer test may indicate combined injury to anterior talofibular and calcaneofibular ligaments.

Quantitative Evaluation of Ankle Instability Using a Capacitance-Type Strain Sensor

2021 ◽  
pp. 107110072199671
Author(s):  
Atsushi Teramoto ◽  
Kousuke Iba ◽  
Yasutaka Murahashi ◽  
Hiroaki Shoji ◽  
Kento Hirota ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Radiographic Images ◽  
Anterior Drawer ◽  
Anterior Drawer Test ◽  
History Of ◽  
The Mean

Background: Manual evaluation is an important method for assessing ankle instability, but it is not quantitative. Capacitance-type sensors can be used to measure the distance on the basis of the capacitance value. We applied the sensor to the noninvasive device for measuring ankle instability and showed its utility. Methods: First, 5 ankles embalmed by Thiel’s method were used in an experiment using a cadaver. The capacitance-type sensor was fixed alongside the anterior talofibular ligament (ATFL) of a specially made brace, and the anterior drawer test was performed. The test had been performed for the intact ankle, with the ATFL transected and with both the ATFL and calcaneofibular ligament (CFL) transected. The anterior drawer distance was calculated by the sensor. Intra- and interinvestigator reliability were also analyzed. Next, as a clinical study, a brace with a sensor was fitted to 22 ankles of 20 patients with a history of ankle sprain. An anterior drawer test at a load of 150 N was conducted using a Telos stress device. The anterior drawer distances measured by the sensor and based on radiographic images were then compared. Results: The mean anterior drawer distances were 3.7 ± 1.0 mm for the intact cadavers, 6.1 ± 1.6 mm with the ATFL transected ( P < .001), and 7.9 ± 1.8 mm with the ATFL and CFL transected ( P < .001). The intrainvestigator intraclass correlation coefficients (ICCs) were 0.862 to 0.939, and the interinvestigator ICC was 0.815. In the experiments on patients, the mean anterior drawer distance measured by the sensor was 2.9 ± 0.9 mm, and it was 2.7 ± 0.9 mm for the radiographic images. The correlation coefficient between the sensor and the radiographic images was 0.843. Conclusion: We quantitatively evaluated anterior drawer laxity using a capacitance-type sensor and found it had high reproducibility and strongly correlated with stress radiography measurements in patients with ankle instability. Capacitance-type sensors can be used for the safe, simple, and accurate evaluation of ankle instability.

Anterior Drawer Test for Acute Anterior Talofibular Ligament Injuries of the Ankle: How Much Load Should be Applied during the Test?

2003 ◽  
Vol 31 (2) ◽  
pp. 226-232 ◽  
Author(s):  
Harukazu Tohyama ◽  
Kazunori Yasuda ◽  
Yasumitu Ohkoshi ◽  
Bruce D. Beynnon ◽  
Per A. Renstrom
Keyword(s):  
Cadaver Study ◽  
Ankle Injuries ◽  
Ligament Injury ◽  
Normal Displacement ◽  
Anterior Talofibular Ligament ◽  
Anterior Drawer ◽  
Anterior Drawer Test ◽  
Ankle Ligament ◽  
Anterior Posterior

Background: There is a lack of consensus regarding the magnitude of load for performing the anterior drawer test in evaluating acute ankle injuries. Purpose: To determine how much load should be applied during the anterior drawer test to detect the integrity of the anterior talofibular ligament. Methods: First, the anterior-posterior load-displacement response of nine cadaveric ankles was measured. Second, anterior displacement of the ankle was measured at 30 and 60 N of anterior load in 14 patients with acute tears of the anterior talofibular ligament. Results: In the cadaver study, the increased displacement by sectioning of the ligament measured at 10, 20, 30, and 40 N of anterior load were significantly greater than those measured at 60 N. In vivo examination of the subjects without anesthesia demonstrated that the injured-to-normal displacement value at 30 N of anterior load was significantly greater than the value at 60 N. Conclusions: This study suggests that a large magnitude of anterior load is not necessary to detect the integrity of the ligament during the anterior drawer test. Clinical Relevance: When evaluating the integrity of the anterior talofibular ligament in cases of acute ankle ligament injury, a relatively low-magnitude load should be applied.

scholarly journals Dynamic Evaluation Of The Effect Of Syndesmotic Injury On Lateral Ankle Stability Using Fluoroscopy

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0002
Author(s):  
Rohan Bhimani ◽  
Go Sato ◽  
Jirawat Saengsin ◽  
Noortje Hagemeijer ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Anterior Drawer ◽  
Intact State ◽  
Tibiofibular Ligament ◽  
Clear Space ◽  
Lateral Ankle Ligament ◽  
Talar Tilt ◽  
The Stability

Category: Ankle; Sports; Trauma Introduction/Purpose: There is a high incidence of concomitance between lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Stress radiographs are an accepted technique to assess the degree of lateral ankle instability by providing a static view of the ankle when subjected to the anterior drawer (AD) and talar tilt (TT) tests. The aim of this study is to assess the effect of syndesmotic injury as well as combined syndesmotic and lateral ankle injury on the stability of the lateral ankle. Methods: Sixteen fresh frozen above-knee amputated cadaveric specimens, divided into two groups, underwent fluoroscopic evaluation for lateral ankle stability. In both the groups, the assessment was first done with all ligaments intact and later with sequential transection of anterior inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), posterior inferior tibiofibular ligament (PITFL), anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). In all scenarios, two loading conditions were considered: (1) Anterior drawer test: 50N and 80N and (2) Talar tilt and Lateral clear space (LCS): 1.7Nm torque. The talar translation, talar tilt, and LCS were measured using Image J. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A p-value <0.05 was considered statistically significant. Results: In group 1 after transection of the AITFL and IOL, an increase in the anterior drawer, talar tilt, and lateral clear space values was found as compared to the intact state. Similarly, in group 2 the anterior drawer, talar tilt, and lateral clear space values significantly increased after transection of the AITFL and ATFL as compared to the intact state (p-values = 0.001). Conclusion: Lateral ankle instability appears after injury to two syndesmotic ligaments (AITFL and IOL), or after one syndesmotic ligament rupture (AITFL) with a concomitant anterior talofibular ligament rupture (ATFL). These findings suggest that surgeons should lower their threshold for stabilizing the syndesmosis if there is a concomitant lateral ankle ligament injury.

Talofibular Interval Changes After Acute Ankle Sprain: A Stress Ultrasonography Study of Ankle Laxity

2013 ◽  
Vol 22 (4) ◽  
pp. 257-263 ◽  
Author(s):  
Theodore Croy ◽  
Susan Saliba ◽  
Ethan Saliba ◽  
Mark W. Anderson ◽  
Jay Hertel
Keyword(s):  
Ankle Sprain ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Talocrural Joint ◽  
Lateral Ankle ◽  
Female Age ◽  
Anterior Drawer ◽  
Main Effect ◽  
Ability Measure ◽  
And Inversion

Introduction:Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US) can image the lateral talocrural joint and allow the measurement of the talofibular interval, which may suggest injury to the anterior talofibular ligament (ATFL). The acute talofibular interval changes after lateral ankle sprain are unknown.Methods:Twenty-five participants (9 male, 16 female; age 21.8 ± 3.2 y, height 167.8 ± 34.1 cm, mass 72.7 ± 13.8 kg) with 27 acute, lateral ankle injuries underwent bilateral stress US imaging at baseline (<7 d) and on the affected ankle at 3 wk and 6 wk from injury in 3 ankle conditions: neutral, anterior drawer, and inversion. Talofibular interval (mm) was measured using imaging software and self-reported function (activities of daily living [ADL] and sports) by the Foot and Ankle Ability Measure (FAAM).Results:The talofibular interval increased with anterior-drawer stress in the involved ankle (22.65 ± 3.75 mm; P = .017) over the uninvolved ankle (19.45 ± 2.35 mm; limb × position F1,26 = 4.9, P = .035) at baseline. Inversion stress also resulted in greater interval changes (23.41 ± 2.81 mm) than in the uninvolved ankles (21.13 ± 2.08 mm). A main effect for time was observed for inversion (F2,52 = 4.3, P = .019, 21.93 ± 2.24 mm) but not for anterior drawer (F2,52 = 3.1, P = .055, 21.18 ± 2.34 mm). A significant reduction in the talofibular interval took place between baseline and week 3 inversion measurements only (F1,26 = 5.6, P = .026). FAAM-ADL and sports results increased significantly from baseline to wk 3 (21.9 ± 16.2, P < .0001 and 23.8 ± 16.9, P < .0001) and from wk 3 to wk 6 (2.5 ± 4.4, P = .009 and 10.5 ± 13.2, P = .001).Conclusions:Stress US methods identified increased talofibular interval changes suggestive of talocrural laxity and ATFL injury using anterior drawer and inversion stress that, despite significant improvements in self-reported function, only marginally improved during the 6 wk after ankle sprain. Stress US provides a safe, repeatable, and quantifiable method of measuring the talofibular interval and may augment manual stress examinations in acute ankle injuries.

scholarly journals Individuals with Recurrent Ankle Sprain Demonstrate Postural Instability and Neuromuscular Control Deficits in Unaffected Side

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Jin Hyuck Lee ◽  
Gi Won Choi ◽  
Woo Young Jang
Keyword(s):  
Ankle Sprain ◽  
Postural Stability ◽  
Ankle Instability ◽  
Neuromuscular Control ◽  
Postural Instability ◽  
Unaffected Side ◽  
Ankle Rehabilitation ◽  
Dynamic Postural Stability ◽  
Recurrent Ankle Sprain ◽  
Anterior Posterior

Category: Ankle, Sports Introduction/Purpose: To compare proprioception, postural stability, and neuromuscular control between patients with mechanical laxity and recurrent ankle sprain. Methods: Among 86 patients with ankle instability, 45 patients had mechanical laxity (mean age 27.2 ± 7.0 years) and 41 had recurrent ankle sprain (mean age 25.1 ± 9.2 years). Both the affected and unaffected ankles of each patient were evalu- ated. Proprioception and neuromuscular control tests were conducted using an isokinetic machine, and postural stability was tested using a postural stabilometry system. Results: Proprioception was not significantly different between the unaffected or affected ankles of the mechanical laxity group compared with those of the recurrent ankle sprain group (n.s). Static and dynamic postural stability and neuromus- cular control were similar in the affected ankles between the two groups (n.s). However, postural stability (static, overall: p = 0.009, anterior– posterior: p = 0.028, medial–lateral: p = 0.022; dynamic, overall: p = 0.012, anterior–posterior: p = 0.004, medial–lateral: p = 0.001) and neuromuscular control (inversion: p = 0.031, eversion: p = 0.039, dorsiflexion: p = 0.029, plantarflexion: p = 0.035) were significantly decreased in the unaffected ankles of the recurrent ankle sprain group compared with those of the mechanical laxity group. Conclusion: The unaffected ankles of the recurrent ankle sprain group showed significant decreases in both postural stability and neuromuscular control compared with the mechanical laxity group. Clinicians and therapists should consider unaffected ankle rehabilitation in patients with recurrent ankle sprain to prevent future sprain events.

Biomechanical analysis of the ankle anterior drawer test for anterior talofibular ligament injuries

1995 ◽  
Vol 13 (4) ◽  
pp. 609-614 ◽  
Author(s):  
Harukazu Tohyama ◽  
Bruce D. Beynnon ◽  
Per A. Renström ◽  
Maureen J. Theis ◽  
Braden C. Fleming ◽  
...  
Keyword(s):  
Biomechanical Analysis ◽  
Anterior Talofibular Ligament ◽  
Ligament Injuries ◽  
Anterior Drawer ◽  
Anterior Drawer Test
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