Table 1 Characteristics of included studies
From: Reliability and validity of physical examination tests for the assessment of ankle instability
Study | Purpose | Sample size | Study population | Examiner/s | Test/s | Reference standard | Statistic |
|---|---|---|---|---|---|---|---|
Alonso et al. [43] | Interrater reliability | 53 | Patients with ankle injuries presenting to private physiotherapy clinics Time since injury: mean 34.2 ± 125 days (range 0–889). Mix acute/chronic 38 males (71.7%), 15 females (28.3%) Age: mean 24.3 ± 8.5 yrs. (range 12–52) | 9 physiotherapists 1–11 yr. experience (mean 5 yrs.) 2 tested each participant | Squeeze test External rotation test The palpation test Dorsiflexion compression test | NA | Kappa, percent agreement |
Croy et al. [44] | Validity | 66 | Individuals with a history of lateral ankle sprains. Time since injury: mean 23.1 ± 30.8 months (range 0.03, 108). Mix acute/chronic 35 males (53%), 31 females (47%) Age: mean 22.7 ± 3.6 yrs | Physical therapist 13 yr. experience | Anterior drawer test | Ultrasound | Sensitivity, specificity, likelihood ratios |
de César et al. [45] | Validity | 56 | Patients with ankle sprains Time since injury: mean 6.6 ± 2.3 days Age: mean 32 ± 13 yrs. (range 18–66) | Lead investigator on study | Ankle external rotation test Squeeze test | MRI | Sensitivity, specificity |
De Simoni et al. [49] | Validity | 30 | Patients with ankle sprains Time since injury: mean 3 days (range 0–19) 15 males (50%), 15 females (50%) Age: mean 33 yrs. (range 19–65) |  | Click test* Suction sign* Tenderness on palpation: Anterior talo-fibular ligament Calcaneo-fibular ligament | MRI | chi-squared test |
George et al. [48] | Validity | 35 | Patients with a history of lateral ankle sprains Time since injury: mean 3.6 ± 3.32 weeks (between 5 days and 12 weeks) 17 males (48.6%), 18 females (51.4%) Age: mean 21.97 ± 7.1 yrs. (range 12–39) | 1 sport medicine physician, 1 experienced musculoskeletal consultant radiologist | Anterior drawer test Talar tilt test | Ultrasound | Sensitivity, specificity, likelihood ratios, p value |
Gomes et al. [16] | Validity | 24 | 10 asymptomatic 14 complaints of ankle instability. Time since injury: mean 18.3 months (range 5–48) 9 males (64.3%), 5 females (35.7%) Age: mean 28 yrs. (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%). Age: mean 32.95 ± 1.55 yrs. (range 16–60) | 2 examiners: 1 senior orthopedic resident 1 orthopedic specialist | Anterior drawer test Inversion stress test Eversion stress test Squeeze test External rotation stress test | MRI | Sensitivity, specificity, positive predictive value, negative predictive value, Kappa, p value |
Li et al. [52] | Interrater reliability and validity | 36 | 36 patients (72 ankles) with suspected anterior talofibular ligament injury 38 ankles (from 31 participants) injured group, 34 ankles (from 29 participants) control group Injured group: 18 males (58%), 13 females (42%). Age: mean 30.4 ± 8.9 yrs Control group: 15 males (52%), 14 females (48%) Age: mean 30.4 ± 8.9 yrs | 2 examiners: 1 junior examiner 1 senior examiner | Anterior drawer test Anterolateral drawer test Reverse anterolateral drawer test | Ultrasound | Sensitivity, specificity, false negative rate, false positive rate, accuracy, Kappa, p value |
Parasher et al. [17] | Intrarater/ interrater reliability | 20 | 12 with ankle sprains, 8 without ankle sprains Measured bilaterally: 40 ankles (total: 16 ankle sprains, 24 injury free) 5 males (25%), 15 females (75%) Age: range 20–30 yrs | 2 testers | Anterior drawer: goniometer Distal fibular position: digital vernier caliper | NA | Intra-class correlation coefficient |
Phisitkul et al. [46] | Validity | 10 | Cadaveric: below the knee specimens (4 pairs, 2 single) 2 intact ligaments, 5 cut anterior talofibular ligament, 3 cut anterior talofibular and calcaneofibular ligament 4 males (6 ankles), 2 females (4 ankles) Age: mean 50 yrs | 2 examiners: 1 Ankle surgeon (anteriolateral draw test) 1 In-training fellow (anterior drawer test) | Anterolateral drawer test Anterior drawer test | Cut ligaments. Direct anatomical measurement | ROC curve, sensitivity, specificity |
Rosen et al. [18] | Validity | 88 | 39 chronic ankle instability, 17 ankle sprain copers, 32 healthy controls 43 males (48.9%), 45 females (51.1%) Age: range 18–35 yrs | 1 rater | Talar test: manual and Ligmaster | History: ankle injuries & Cumberland Ankle Instability Tool | Sensitivity, specificity, diagnostic odds ratio |
Sman et al. [47] | Validity | 87 | Acute ankle sprains. 38 ankle syndesmosis injury, 42 Lateral sprain, 4 midfoot sprain, 1 medial ankle sprain, 2 pain no sprain Time since injury: mean 2.5 ± 3.8 days 78% male Age: mean 24.6 ± 6.5 yrs | 13 clinicians: sports clubs, sports medicine, physiotherapy practices. 1–35 yrs. experience (mean 12 yrs.) | Dorsiflexion-external rotation test Dorsiflexion lunge with compression Squeeze test Syndesmosis ligament palpation | MRI | Sensitivity, specificity, likelihood ratios, accuracy, odds ratios |
Van Dijk et al. [54] | Interrater reliability and validity | 160 | Patients with acute injury (within 48 h) to the lateral ligaments 116 males (72.5%, 44 females (27.5%) Age: mean 27.3 years (range 18–40 years) | 5 examiners 1 experienced orthopaedic surgeon, 4 inexperienced doctors | Anterior drawer test Tenderness on palpation: Anterior talo-fibular Ligament Calcaneo-fibular Ligament Syndesmosis Medial Talocrural joint Peroneal tendon Lateral malleolus Diffusely lateral Supination line | Arthrography | Kappa, sensitivity, specificity |
Vaseenon et al. [51] | Intrarater/ interrater reliability and validity | 9 | Cadaveric: human ankle specimens (4 pairs, 1 single) 3 intact ligaments, 3 cut anterior talofibular ligament, 3 cut anterior talofibular and calcaneofibular ligament 2 males, 3 females Age: mean 55 yrs. (range 48–70) | 8 testers: 4 athletic training students (mean experience: 2.25 yrs.), 4 senior orthopaedic trainees (mean experience 4.5 yrs.) | Anterolateral drawer test Anterior drawer test | Cut ligaments. Direct anatomical measurement | Intra-class correlation coefficient, ROC, sensitivity, specificity, |
Wilkin et al. [19] | Interrater reliability | 60 | 38 sprainers, 22 non-sprainers, 3 additional ankle injuries 9 males (15%), 51 female (85%) Age: range 17–50 yrs | 5 raters: 4 experienced physiotherapists, 1 undergraduate student (compared 2 experienced & student) | Anterior drawer in supine Anterior drawer in Crook lying Talar tilt Inversion tilt | NA | Intra-class correlation coefficient |