What is the role of anterior drawer test in the evaluation of ankle sprains?

Updated: Jan 14, 2019
  • Author: Craig C Young, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

Anterior drawer and talar tilt examinations are used to assess ankle instability; however, the use of these tests in acute injuries is in question because of pain, edema, and muscle spasm.

For the anterior drawer test (as shown in the image below), the patient's knee must be flexed to relax the gastrocsoleus complex, and the foot should be in 10° of plantar flexion. Grasp the heel and pull forward while, with the other hand, providing counterpressure over the front of the tibia at the level of the ankle. A firm endpoint will be absent. Repeat these steps for the other ankle, and compare results. In a person with lax joints, the presence of several millimeters of bilateral movement is a negative ankle drawer-sign finding. In a positive ankle drawer-sign finding, there is a difference in movement in a relaxed patient between the injured side and the uninjured side, with the injured side having more movement than the uninjured one.

Sometimes, a dimple appears over the area of the ATFL on anterior translation. This so-called dimple (or suction) sign indicates compromise of the ATFL. It may be accompanied by pain, but muscle spasms are minimal.

The anterior drawer test is not very reliable, especially if the findings are negative in a patient who is not under anesthesia, because of muscle guarding by the patient. The normal amount of translation is 2 mm. Reports indicate that 4 mm of laxity in the ATFL provides a clinically apparent test result.

Anterior drawer test. Anterior drawer test.

The prone anterior drawer test is another test for ligamentous instability. The patient must lie prone with the feet extending over the end of the examining table. The examiner then pushes the heel steadily forward with one hand. A positive test result consists of excessive anterior movement and a dimpling of the skin on both sides of the Achilles tendon.


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