Anterior Drawer Test, ADT, is an essential physical examination to evaluate the ankle instability. ADT is a convenient, non-cost, and dynamic evaluation. However, it has been pointed out this procedure can be subjective and lacks reproducibility, especially for less experienced clinicians. We need physical examination with high reproducibility. The aim of this study was to evaluate the usefulness of a novel, modified ADT and compare the reproducibility and accuracy of traditional and novel ADTs. The subjects were 13 ankles with or without a history of ankle sprain. First, all patients underwent stress radiography and ankle instability was defined. Second, all patients underwent manual ADT. Junior resident doctor and senior orthopedic surgeon, two examiners judged the presence or absence of ankle instability and measured actual distance of anterior displacement during the manual ADT using a sensor device. In lateral stress radiographs, anterior drawer stress was applied using the TELOS stress device. The distance of anterior drawer translation was measured from the posterior lip of the tibial platform to the nearest articular surface of the TELOS. In comparison with the unstressed position, anterior translation of the TELOS of more than 3.5 mm was considered instability. To perform traditional ADT, the patient was seated on the edge of examination bed with the calf hanging over. The examiner pulled the calcaneus of the subject forward with one hand while pushing the tibia backward with the other hand. Fixed ADT was performed in the supine position with the lower leg pressed on a board with a hip and knee flexion. The examiner stabilized the lower leg on the board, pulled the calcaneus forward with one hand. To clarify the actual distance of anterior displacement in the manual ADT, we evaluated anterior displacement measurements using a capacitance type sensor device. The sensor was fixed with a snap button to the lateral malleolus and talar part of the brace. And the anterior drawer distance was calculated from the lengthening measured by sensor. Results. This table shows the diagnostic accuracy of two ADTs. In the junior examiner, the sensitivity of traditional ADT was relatively low. And the sensitivity of fixed ADT was higher than traditional ADT. These graphs show the distance of anterior displacement using sensor device during ADT. In traditional ADT, the distance of anterior displacement measured by the junior examiner was significantly lower than the senior examiner. In fixed ADT, there was no significant difference between junior and senior examiner. The graphs are the relationship of the distance of anterior displacement between the junior and senior examiner. In fixed ADT, the distance of anterior displacement was significantly correlated between junior and senior examiner. Discussion. Several studies showed the internal rotation of the ankle increases the diagnostic sensitivity and axial load reduces the sensitivity. In general, ADT by less experienced clinicians is lower accuracy and reproducibility. In this study, the distance of anterior displacement measured by the junior examiner was significantly lower than the senior examiner. So, in traditional ADT, skilled technique is required for accurate diagnosis. Traditional ADT. Examiners need to evaluate ankle instability by the relative movements of both hands, and subtle sensations are required. It is not easy to relieve gastrocnemius muscle spasms. In the other hand, fixed ADT, examiners may decrease the sensation of relative hand movements by stabilizing the distal tibia with one hand. Pressing the lower leg on the board with the hip and knee flexion make it easy for them to relax and relieve gastrocnemius muscle spasms. Fixed ADT is a particularly preferred method for evaluation of ankle instability by less experienced examiners. Conclusions. Thank you for attention.

Anterior Drawer Test

ankle instability

reproducibility

modified ADT

fixed ADT