High reproducibility of a novel fixed anterior drawer test for diagnosing ankle instability

Abstract BackgroundThe manual traditional anterior drawer test (ADT) is essential for deciding the treatment for chronic ankle instability, but it has been shown to have a comparatively low reproducibility and accuracy, especially in less experienced hands. To clarify the inter-examiner reproducibility, we compared the actual distance of anterior translation between junior and senior examiners in ADT. We also evaluated the diagnostic abilities of traditional ADT, and a novel modified ADT (fixed ADT).MethodsThirty ankles were included in this study, and ankle instability was defined using stress radiography. All subjects underwent two methods of manual ADT by junior and senior examiners, and ankle instability was judged in a blinded fashion. The anterior drawer distance was calculated from the lengthening measured using a capacitance-type sensor device. ResultsThe degree of anterior translation determined by the junior examiner was significantly lower than that determined by the senior examiner when traditional ADT was performed (3.3 vs. 4.5 mm, P=0.016), but there was no significant difference in anterior translation between the two examiners when fixed ADT was performed (4.6 vs. 4.1 mm, P=0.168). The inter-examiner reliability of fixed ADT was higher than that of traditional ADT. For the junior examiner, the diagnostic accuracy of fixed ADT was higher than that of traditional ADT (sensitivity, 0.40 vs. 0.80; specificity, 0.75 vs. 0.80).ConclusionFixed ADT may have the advantage of being a simple manual test of ankle instability with less error between examiners.