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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