Anterior Drawer of the Ankle

This test is used in the clinic to check the ligament instability in the ankle.
This test is applied by to therapist or doctor in the clinic.
This test is determined to ankle mechanical hyper mobility /instability in the sagittal plane of the joint of talocrural joint/upper ankle joint is present.

Table of Contents

Purpose of the Anterior Drawer of the Ankle:

This test is designed primarily to test for injuries to the anterior talofibular ligament in the ankle.

The starting position of the patient for the test is supine.
In the supine position with the foot relaxed.
The examiner stabilizes the tibia & fibula, holds the patient’s foot in 20′ of plantar flexion,& draws the talus forward in the ankle mortise.
sometimes, a dimple appears over the area of the anterior talofibular ligament on anterior translation means dimple/suction sign.
If pain & muscle spasms are minimal.
In the plantar-flexed position, the anterior talofibular ligament is perpendicular to the long axis of the tibia.
By adding inversion, which gives anterolateral stress, the examiner can increase the stress on the anterior talofibular ligament & the calcaneofibular ligament.

A positive anterior drawer test may be obtained with a tear of only the anterior talofibular ligament, but anterior translation is greater if both ligaments are torn, especially if the foot is tested in dorsiflexion.
If straight anterior movement or translation occurs, the test indicates both medial & lateral ligament insufficient.

This bilateral finding, which is often more evident in dorsiflexion, means that the superficial & deep deltoid ligaments, as well as the anterior talofibular ligament & anterolateral capsule, have been torn.
If the tear is on only one side, only that side would translate forward.
For example, with a lateral tear, the lateral side would translate forward, causing medial rotation means internal rotation of the talus & resulting in anterolateral instability, which is increasingly evident with growing plantar flexion of the foot.

Ideally, the knee should be placed in 90′ of flexion to alleviate tension on the Achilles tendon.
The test should be performed in plantar flexion & in dorsiflexion to test for straight & rotational instabilities.

The test may also be performed by stabilizing the foot & talus &pushing the tibia/fibula posteriorly on the talus.
In this case, excessive posterior movement of the tibia & fibula on the talus indicates a position test.

Another test is in patient 66.
Which is measured in lateral ankle sprain.
Sensitivity of the Anterior Drawer of the Ankle = at 2.3 mm or greater = 0.74 & at 3.7 mm or greater = 0.83
Specificity of the Anterior Drawer of the Ankle = at 2.3 mm or greater =0.38 & at 3.7 mm or greater = 0.40
This result is compared with to an ultrasound.
Positive likelihood ratios at 2.3 mm or greater = 1.2 & at 3.7 mm or greater =1.4
The negative likelihood ratios at 2.3 mm or greater = 0.66 & at 3.7 mm or greater = 0.41.