Execution
- 1Position the patient sitting or supine with the knee flexed and the ankle relaxed.
- 2Place the ankle in approximately 10 to 20 degrees of plantarflexion.
- 3Stabilize the distal tibia and fibula with one hand.
- 4Cup the calcaneus with the other hand and translates the talus anteriorly.
- 5Compare anterior translation, end feel, pain, and dimpling with the opposite ankle.
Positive outcome
Excessive anterior talar translation, a soft end feel, pain, or a suction dimple sign is positive for ATFL injury. A side-to-side difference of about 5 to 10 mm is commonly considered abnormal. The ankle anterior drawer is different from the knee anterior drawer and targets the lateral ankle ligament complex.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| van Dijk et al. (1996) | delayed physical examination study | 96 | 84 | 6.0 | 0.05 |
| Beynon et al. (2022) | systematic review | NA | NA | NA | NA |
CommentVan Dijk's strong numbers refer to delayed physical examination after several days rather than immediate post-injury testing. Acute swelling, pain, and guarding reduce accuracy, so repeating the exam after 4 to 5 days can be more informative. The test is stronger when combined with swelling, hematoma, and palpation findings.
Moderate Clinical Value