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

Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):55-62. doi: 10.1007/s00167-019-05705-x. Epub 2019 Sep 26.


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).

Keywords: Ankle sprains; Anterior drawer test; Anterior talofibular ligament; Anterolateral drawer test; Reverse anterolateral drawer test.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Ankle Injuries / diagnosis*
  • Ankle Injuries / diagnostic imaging
  • Ankle Joint / diagnostic imaging
  • Chronic Disease
  • Double-Blind Method
  • Female
  • Humans
  • Joint Instability / diagnosis*
  • Joint Instability / diagnostic imaging
  • Lateral Ligament, Ankle / diagnostic imaging
  • Lateral Ligament, Ankle / injuries*
  • Male
  • Physical Examination / methods*
  • Prospective Studies
  • Random Allocation
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Ultrasonography
  • Young Adult