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New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy

Abstract

Purpose

To diagnose chronic ankle instability, clinicians frequently use manual anterior drawer test and stress radiography. However, both exams can yield incorrect results and do not reveal the extent of ankle instability. The use of stress ultrasound during a manual anterior drawer stress procedure might enable the diagnosis of chronic ankle instability.

Methods

Seventy-three patients with chronic ankle pain or laxity after remote ankle sprain were included. The study population included 41 males and 32 females. The mean age of the patients at the time of the operation was 29 years. A standardized physical examination (manual anterior drawer test), stress radiography and stress ultrasonography were performed to assess the anterior talofibular ligament (ATFL). Ultrasound images were taken in the resting position and the maximal anterior drawer position. The statistical significance of stress ultrasound among the three groups according to manual anterior drawer test and a specific degree (5 mm) of anterior translation of stress radiography were analysed. Correlation coefficients between stress ultrasound, stress radiography and manual anterior drawer test were calculated.

Results

There was a significant difference for ATFL length (ATFL stress) and ATFL ratio (ATFL stress/ATFL resting) among the three groups (both p < 0.001). However, there was no significant difference for anterior translation of stress radiography among three groups according to manual anterior drawer test (p = 0.159). There was a significant difference for ATFL length (ATFL stress) and ATFL ratio between two groups with 5-mm anterior translation of stress radiography (p = 0.002 and p = 0.011, respectively). The mean value of grade of manual anterior drawer test between the two groups also differed (p = 0.021). There was a moderately positive linear relationship between stress ultrasound and manual anterior drawer test. Also, there was a positive linear relationship between stress ultrasound and stress radiography.

Conclusion

The results suggest that the value of ATFL length (ATFL stress) and ATFL ratio of stress ultrasound could be used for diagnosis of chronic ankle instability in addition to manual anterior drawer test and stress radiography.

Level of evidence

III.

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Authors and Affiliations

  1. Foot and Ankle Service, KT Lee’s Orthopedic Hospital, Seoul, Korea

    Kyung Tai Lee, Hyuk Jegal, Jong Won Park & Jung Pil Choi

  2. Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, 443-380, Gyeonggi-do, Republic of Korea

    Young Uk Park

  3. Foot and Ankle Clinic, Department of Orthopedic Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea

    Jin Su Kim

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  1. Kyung Tai Lee
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Correspondence to Young Uk Park.

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Lee, K.T., Park, Y.U., Jegal, H. et al. New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound. Knee Surg Sports Traumatol Arthrosc 22, 1701–1707 (2014). https://doi.org/10.1007/s00167-013-2690-x

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  • DOI: https://doi.org/10.1007/s00167-013-2690-x

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