Execution
- 1Seat the patient in a chair.
- 2Ask the patient to cross the injured leg over the knee of the uninjured leg.
- 3Position the mid-tibia of the injured leg over the opposite knee.
- 4Apply gentle downward pressure over the medial knee or distal leg of the injured side.
- 5Ask whether syndesmosis-region pain is reproduced.
Positive outcome
Pain over the distal syndesmosis region is positive. The maneuver indirectly loads the tibia and fibula and may provoke high ankle sprain symptoms. Pain only at the contact point over the leg or knee is not a true positive.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Kiter et al. (2005) | NA | NA | NA | NA | NA |
| Sman et al. (2013) | systematic review, limited individual-test evidence | NA | NA | NA | NA |
CommentMagee illustrates the crossed-leg test as a syndesmosis provocation maneuver. The test is less common than Kleiger or squeeze tests and has limited validation. It may be useful when direct ankle stress is not tolerated, but it should not drive diagnosis alone.
Low Clinical Value