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Reverse anterolateral drawer test is more sensitive and accurate for diagnosing chronic anterior talofibular ligament injury

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To diagnose chronic anterior talofibular ligament (ATFL) injury, three different physical examinations were compared: the anterior drawer test (ADT), the anterolateral drawer test (ALDT), and the reverse anterolateral drawer test (RALDT).

Methods

A total of 72 ankles from potential ATFL-injured patients and the normal population were included and examined using the ADT, ALDT, and RALDT by two examiners without knowing the injury histories of any of the participants. Ultrasound examination was then applied as the gold standard to divide the ankles into the ATFL-injured group and the control group. The sensitivity (Se), specificity (Sp), false negative rate (FNR), false positive rate (FPR), accuracy, κ value, and p value of the two examiners’ diagnoses were calculated to assess the diagnostic ability of each examination.

Results

There were 38 ankles in the injured group and 34 ankles in the control group. No significant difference was found between the two groups in terms of gender, age, body mass index (BMI), and included ankles. In the ADT and ALDT groups, the specificity reached one, while the sensitivity was relatively low (0.053 and 0.477 for the junior examiner and 0.395 and 0.500 for the senior examiner). In the RALDT, both the sensitivity and specificity were greater than 85% (0.868 and 0.912 for the senior examiner and 0.921 and 0.882 for the junior examiner). The κ value of the RALDT (0.639) was higher than that of the ALDT (0.528) and the ADT (0.196), whereas all the p values were less than 0.05.

Conclusion

The ADT and ALDT are valuable physical tests to assess ATFL injuries. Compared with the traditional ADT and ALDT, however, the RALDT is more sensitive and accurate in diagnosing chronic ATFL injuries.

Level of evidence

II (diagnostic).

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Funding

This work was funded by the National Science Foundation of China (Nos. 81572209).

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Author notes

  1. Qianru Li and Yingchun Tu contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China

    Qianru Li & Yinghui Hua

  2. Department of Orthopedics, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China

    Yingchun Tu

  3. Department of Orthopedics, Dongyang People’s Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China

    Jun Chen

  4. Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China

    Jieling Shan

  5. Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

    Patrick Shu-Hang Yung & Samuel Ka-Kin Ling

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  1. Qianru Li
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Correspondence to Yinghui Hua.

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The authors declare that they have no conflicts of interest in the authorship and publication of this contribution.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the review board of Fudan University (Reference Number: KY2106-314).

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Li, Q., Tu, Y., Chen, J. et al. Reverse anterolateral drawer test is more sensitive and accurate for diagnosing chronic anterior talofibular ligament injury. Knee Surg Sports Traumatol Arthrosc 28, 55–62 (2020). https://doi.org/10.1007/s00167-019-05705-x

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  • DOI: https://doi.org/10.1007/s00167-019-05705-x

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