The accuracy of clinical tests in diagnosing ankle ligament injury

Our purpose was to summarize the literature on the diagnostic accuracy and clinical utility of orthopaedic special tests for the talocrual ligaments and to assess the diagnostic accuracy of clinical tests used to diagnose talocrual joint ligament injuries. A systematic search of eight electronic databases was conducted following PRISMA guidelines. Retrieved articles were screened by title, abstract and full text. Studies that met all inclusion criteria were assessed using the QUADAS tool. Specificity, sensitivity, positive and negative likelihood ratios were calculated. The search retrieved 3283 articles of which a final total of five met the inclusion criteria. All five articles assessed the anterior drawer test (ADT), while two articles also assessed the talar tilt test (TTT). Specificity for the ADT assessed by arthrography ranged from 67.3 to 93.9 and sensitivity from 12 to 89.0, with minimal to small+LR and minimal to moderate -LR post-test probability. The TTT was also found to have a high specificity but low sensitivity. The ADT and TTT may have utility in the early diagnosis of ankle-ligament injuries especially when they are positive and associated with clinical findings. They should not be relied upon when returning negative results, suggesting further assessment may be warranted. Despite their common clinical use, there is limited literature available on the validity of common clinical tests of ankle stability and more research is required to further evaluate their accuracy.