New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound.

Abstract

PURPOSE: To diagnose chronic ankle instability, clinicians frequently use manual

anterior drawer test and stress radiography. However, both exams can yield

incorrect results and do not reveal the extent of ankle instability. The use of

stress ultrasound during a manual anterior drawer stress procedure might enable

the diagnosis of chronic ankle instability. METHODS: Seventy-three patients with

chronic ankle pain or laxity after remote ankle sprain were included. The study

population included 41 males and 32 females. The mean age of the patients at the

time of the operation was 29 years. A standardized physical examination (manual

anterior drawer test), stress radiography and stress ultrasonography were

performed to assess the anterior talofibular ligament (ATFL). Ultrasound images

were taken in the resting position and the maximal anterior drawer position. The

statistical significance of stress ultrasound among the three groups according to

manual anterior drawer test and a specific degree (5 mm) of anterior translation

of stress radiography were analysed. Correlation coefficients between stress

ultrasound, stress radiography and manual anterior drawer test were calculated.

RESULTS: There was a significant difference for ATFL length (ATFL stress) and

ATFL ratio (ATFL stress/ATFL resting) among the three groups (both p < 0.001).

However, there was no significant difference for anterior translation of stress

radiography among three groups according to manual anterior drawer test (p =

0.159). There was a significant difference for ATFL length (ATFL stress) and ATFL

ratio between two groups with 5-mm anterior translation of stress radiography (p

= 0.002 and p = 0.011, respectively). The mean value of grade of manual anterior

drawer test between the two groups also differed (p = 0.021). There was a

moderately positive linear relationship between stress ultrasound and manual

anterior drawer test. Also, there was a positive linear relationship between

stress ultrasound and stress radiography. CONCLUSION: The results suggest that

the value of ATFL length (ATFL stress) and ATFL ratio of stress ultrasound could

be used for diagnosis of chronic ankle instability in addition to manual anterior

drawer test and stress radiography.