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Anterior Drawer Test Ankle

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Clinical demonstration of anterior drawer test of the ankle[1]
Illustration of anterior drawer test[2]
Anterior drawer test to assess the integrity of the anterior fibular ligament[3]
  • Anterior Drawer of the Ankle
  • Anterior Drawer Test Ankle
  • Anterior Drawer Test for Ankle
  • Prone Anterior Drawer Test

Purpose

Description

  • Patient is seated with feet hanging or supine
  • The heal is placed in the palm of the examiners hand
    • Foot should be in 10-15° of plantarflexion
  • The examiner then translates the calcaneus anteriorly
  • A positive exam is greater than 1 cm of translation compared to the healthy ankle
    • There may be a poor end feel
    • Graded on a scale of 0 (no laxity) to 3 (gross laxity)

Modification

  • The test can be performed with the patient prone
  • Foot is hanging off examination table
  • Stabilize the heel with one hand, foot with the other
  • Pull foot forward
  • Positive test
    • Laxity

Pathology

Evidence

Lateral Ankle Sprain

  • Van Dijk et al prospective, blinded study of 160 patients injured within 48 hours of exam[4]
    • Sensitivity: 96%
    • Specificity: 84%
  • Phisitkul et al cadaveric study of 10 ankles[5]
    • Sensitivity: 75%
    • Specificity: 50%
  • Blanchard et al prospective study of 142 patients examined within 5 days, 216 health controls[6]
    • Sensitivity: 32%
  • Croy et al prospective study of 66 patients with a history of lateral ankle sprain[7]
    • Sensitivity: 74-83%
    • Specificity: 38-40%
  • Fujii et al cadaveric study of 6 ankles by 5 blinded examiners[8]
    • Sensitivity: 60%
    • Specificity: 74%

Syndesmotic Sprain

  • Grobterlinden Et al[9]
    • Sensitivity: 44.4%
    • Specificity: 67.8%
    • PPV: 44.4%
    • NPV: 66.7%

See Also

References

  1. ↑ McGovern, Ryan P., and RobRoy L. Martin. "Managing ankle ligament sprains and tears: current opinion." Open access journal of sports medicine 7 (2016): 33.
  2. ↑ Almoallim, Hani, et al. "Approach to Musculoskeletal Examination." Skills in Rheumatology (2021): 17-65.
  3. ↑ Wolfe, Michael W., et al. "Management of ankle sprains." American family physician 63.1 (2001): 93-105.
  4. ↑ van Dijk CN, Lim LSL, Bossuyt PMM, Marti RK. Physical Examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg. 1996; 78-B: 958-962.
  5. ↑ Phisitkul, Phinit, et al. "Accuracy of anterolateral drawer test in lateral ankle instability: a cadaveric study." Foot & ankle international 30.7 (2009): 690-695.
  6. ↑ Blanshard, K. S., et al. "A radiological analysis of lateral ligament injuries of the ankle." Clinical radiology 37.3 (1986): 247-251.
  7. ↑ Croy, Theodore, et al. "Anterior talocrural joint laxity: diagnostic accuracy of the anterior drawer test of the ankle." journal of orthopaedic & sports physical therapy 43.12 (2013): 911-919.
  8. ↑ Fujii, Tadashi, et al. "The manual stress test may not be sufficient to differentiate ankle ligament injuries." Clinical biomechanics 15.8 (2000): 619-623.
  9. ↑ Großterlinden, Lars Gerhard, et al. "Isolated syndesmotic injuries in acute ankle sprains: diagnostic significance of clinical examination and MRI." Knee Surgery, Sports Traumatology, Arthroscopy 24.4 (2016): 1180-1186.
Created by:
John Kiel on 12 July 2019 00:33:03
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Last edited:
17 September 2025 18:24:51
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