Diagnostic Value of Ultrasound in Ankle Sprain

Reliability and validity of physical examination tests for the assessment of ankle instability

“…(range 23–42) 2 resident physicians trained by senior orthopaedic surgeon Anterolateral talar palpation Anterior drawer test MRI (only for cases) Sensitivity, specificity, predictive values, accuracy Großterlinden et al [ 50 ] Interrater reliability and validity 96 Patients with acute ankle sprains 55 males (57%), 41 females (43%) Age: mean 32.6 ± 10.2 yrs. (range 18–59) 2 examiners: 1 senior, 1 resident Tenderness on palpation: Anterior inferior tibiofibular ligament Proximal fibula Deltoid ligament Anterior talo-fibular ligament Calcaneo-fibular ligament Syndesmosis Squeeze test External rotation test Drawer test Cotton test Crossed-leg test MRI Weighted Kappa, percent agreement, sensitivity, specificity, predictive values Hosseinian et al [ 53 ] Interrater reliability and validity 105 Patients with ankle injuries presenting to a hospital. 47 male (55.2%), 58 female (55.2%).…”

“…Three studies assessed the reliability of the external rotation test [ 43 , 50 , 53 ], and the squeeze test [ 43 , 50 , 53 ]. Two studies assessed the reliability of the anterolateral drawer test [ 51 , 52 ], and the inversion tilt test [ 19 , 53 ]. Only one study assessed the reliability of syndesmosis ligament palpation [ 43 ], the dorsiflexion compression test [ 43 ], tenderness of anterior inferior tibiofibular ligament, proximal fibular, deltoid ligament, anterior talofibular ligament and calcaneo-fibular ligament [ 50 ], the cotton test [ 50 ], the crossed-leg test [ 50 ], distal fibular position [ 17 ], the reverse anterolateral drawer test [ 52 ], talar tilt [ 19 ], and the eversion tilt test [ 53 ].…”

“…Two studies assessed the validity of a talar tilt test [ 18 , 48 ], and tenderness of the syndesmosis [ 47 , 54 ]. Only one study assessed the validity of dorsiflexion lunge with compression [ 47 ], tenderness of anterior inferior tibiofibular ligament [ 50 ], proximal fibular [ 50 ], deltoid ligament [ 50 ], medial ankle [ 54 ], talocrural joint [ 54 ], peroneal tendon [ 54 ], lateral malleolus [ 54 ], diffusely lateral [ 54 ], supination line [ 54 ], the cotton test [ 50 ], the crossed-leg test [ 50 ], the reverse anterolateral drawer test [ 52 ], the inversion stress test [ 53 ], and the eversion stress test [ 53 ]. Table 5 reports an overview of the results from studies assessing validity.…”

“…However, two of these studies are cadaveric studies [ 46 , 51 ]. A range of different reference standards were used within these studies, including ultrasound [ 44 , 48 , 52 ], MRI [ 16 , 50 , 53 ], arthrography [ 54 ], and cutting the ligaments and measured with direct anatomical measurements [ 46 , 51 ]. There were also differences in how the anterior drawer test was conducted and scores interpreted.…”

“…The two tests with the highest reported inter-rater reliability were the external rotation and the anterior drawer tests, rated as substantial [ 43 ] and good [ 17 ] agreement respectively. However, other studies have rated the inter-rater reliability of the anterior drawer test as slight [ 52 ] and poor [ 19 ], and the external rotation test as fair [ 50 , 53 ], demonstrating inconsistent results. The only test to show some consistent results based on more than one included study was the squeeze test, which was rated as having moderate inter-rater reliability based on results from two studies [ 43 , 50 ].…”