What is Anterior Drawer Test | Physiotherapy

Anterior Drawer Test (Ankle)

Overview of anterior drawer test (Ankle)

The anterior drawer test assesses the constancy of the anterior talofibular ligament. Normally, you should be able to shift your foot slightly forward over the ankle before reaching a relatively firm endpoint provided by the anterior talofibular ligament.

Purpose of anterior drawer test

The purpose of this test was to determine if there is mechanical instability of the ankle or hypermobility in the sagittal plane of the talocrural joint (or superior ankle joint).

Quick facts of anterior drawer test

The anterior drawer test is a physical exam that doctors use to assess the stability of the anterior cruciate ligament (ACL) in the ankle. Doctors can use this test, along with imaging and other tests, to determine if a person has injured the anterior cruciate ligament and to recommend treatment options.

This test may not be as accurate in diagnosing an ACL injury as other diagnostic options.

What to expect

Typically, a doctor can perform an anterior drawer test in less than five minutes. The ladders for the anterior drawer test are frequently as follows:

  • You will lie on an exam table.
  • A doctor will ask you to bend your knee and put your foot on the exam table.
  • Your doctor will place your hands on either side of your lower knee joint. They will apply gentle pressure behind the knee and try to move the lower leg slightly forward. Your foot will remain on the exam table during this time.
  • If your tibia (lower leg) moves out of place during the test, this indicates an ACL injury. Your ACL is responsible for preserving the stability of the tibia. If the tibia is moving forward, this indicates to a doctor that the ACL is not working properly.
  • A physician will rate or estimate the severity of the injury based on how far the ACL can travel. They rate the tear from one to three (I, II, or III), with three being the worst tear. A score I tear moves 5 millimeters, a grade II tear moves 5 to 10 millimeters, and a grade III tear interchanges more than 10 millimeters.
  • A doctor may also perform this test while you are sitting with your feet flat on the floor. Ideally, the exam should not be painful, and you usually don’t need to do anything special to prepare.

The procedure of anterior drawer test

Anterior ankle drawer laxity and stiffness were evaluated using 4 test conditions combining 2 knee locations (90 ° and 0 ° flexion) and 2 ankle positions (neutral [0 °] and 10 ° FP). Therefore, the 4 test conditions were as follows: (1) knee at 90 ° flexion, ankle at 0 ° FP; (2) knee at 90 ° flexion, ankle at 10 ° FP; (3) knee at 0 ° flexion, ankle at 0 ° FP; and (4) knee at 0 ° flexion, ankle at 10 ° FP.

Athletes participated in a test session, during which all anterior drawer measurements were obtained using the ankle arthrometric procedures described above22–, 24,26,27 A restraint strap was secured around the distal lower leg 1 cm above the malleoli to avoid the lower leg. movement during the test.

The examiner secured the arthrometer to the foot by placing the sole of the foot on the base plate and tightening the dorsal and heel braces. The heel clamp prevented the device from rotating on the calcaneus, while the dorsal clamp secured the foot to the platform. The tibial pad was then placed 5 cm above the malleoli of the ankle and attached to the lower leg.

To minimize variation, the arthrometer was oriented and positioned on all participants similarly for all tests, and the same examiner (J.E.K.) performed all tests. The order of the test was balanced and randomly assigned between the right and left ankles and by the position of the knee (90 ° or 0 ° of flexion) and the position of the ankle (0 ° or 10 ° of FP). Once the ankle measurements were obtained, the device was removed and the test procedure was repeated on the opposite ankle.

Test position

supine or sitting.

Diagnostic precision

Compassion: .71; Specificity: .33; + LR: 1.06, -LR: .88

Importance of the test

The anterior drawer test is a beneficial test to perform on a patient afterward an inversion ankle sprain (wound to the lateral collateral ligaments). The 3 main components of the lateral collateral ligaments of the ankle include the anterior talofibular ligament (ATFL), the calcaneofibular ligament, and the posterior talofibular ligament.

The ATFL runs from the anterior aspect of the lateral malleolus to the anterior medial aspect of the neck of the talus. The role of the ATFL is to resist the anterior translation of the ankle and prevent inside rotation of the talus on the tibia. Based on the anatomical orientation, placing the ankle in 10-15 degrees of plantar flexion places a strain on the ligament, which is enhanced when a posterior to anterior translation is applied. Because there is a subjective rating scale (0-3) for laxity, it is important for the novice clinician to critically assess the patient’s movement and response during testing.

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