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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Anterior Drawer Test


- Discussion:
    - Anterior Talofibular ligament is the primary restraint in anterior drawer test;
    - testing of ankle in 10 deg of plantar flexion results in greatest amount of translation, although one cadaveric study showed that maximum anterior excursion occurs in dorsiflexion;
            - injury of the calcaneofibular lig does not increase amount of the anterior drawer;
    - evaluates the Anterior Talofibular ligament (look for diff. of 8 mm)
    - this can be performed by securing the distal leg with one hand and applying an anterior pull on the heel with the foot held in gentle plantar flexion;

- Testing w/ Pt Sitting:
    - when patient is sitting, knee should be flexed over edge of bench or table and the ankle should be allowed to fall into equinus;
    - examiner then stabilizes distal part of leg w/ one hand and applies anterior force to the heel with the other hand, in attempt to subluxate the talus anteriorly from beneath the tibia;
    - be sure to allow the talus to rotate slightly medially which relaxes the deltoid ligament (which otherwise might give a false negative test);

- Testing w/ Pt Supine:
    - modified anterior drawer test can be used when pt is supine;
    - flexing the knee to about 45 deg relaxes the calf muscles;
    - w/ knee hyperflexed, the ankle in equinus, & foot fixed by one of examiner's hands to the ground or table, force is applied w/ other hand on anterior aspect of distal part of leg, in attempt to  translate the tibia posteriorly;          
    - alternatively, w/ pt supine on a table w/ knees flexed about 90 deg, posterior force is applied to the lower leg while foot is held flat on the table top;
    - be sure to allow the talus to rotate slightly medially which relaxes the deltoid ligament (which otherwise might give a false negative test);

- Radiographs:
    - forward shift of more than 8 mm on a lateral radiograph is considered diagnostic for an ATFL tear;
    - distance measured between the posterior lip of the tibia & nearest part of talus reflects anterior subluxation of the talus



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, October 29, 2012 11:50 am