Are High Ankle Sprain Tests Accurate?

Accuracy of High Ankle Sprain Tests

INTRO:
A high ankle sprain involves injury to the distal tibiofibular syndesmosis, a fibrous joint stabilized by four ligaments:
AITFL, IOL, PITFL, TTFL.
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Syndesmotic injuries take 2x as long vs. a low ankle sprain to return to sport.
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Inaccurate or delayed diagnosis can lead to repeated episodes of ankle instability, predisposing to early degenerative changes, and post-traumatic OA.
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Diagnosis should quantify the degree of instability, as unstable injuries are prioritized for surgery vs. conservative treatment.
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Arthroscopy, MRI, & diagnostic ultrasound provide high sensitivity and specificity, however, access may be limited.
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Physical examination remains a central tenet for diagnosis, including:
Squeeze test.
External rotation test.
Cotton test.
Crossed-leg test.
Heel-thump test.
Palpation.
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This systematic review determined the diagnostic accuracy of clinical tests and proposed an algorithm for optimizing test clustering.
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RESULTS:
6 studies
512 participants
13 clinical tests
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No individual test was associated with both high sensitivity and high specificity.
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Tests with the highest sensitivity:
Palpation 92%
Dorsiflexion lunge 75%
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Tests with the highest specificity:
Squeeze test 85%
External rotation 78%
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CONCLUSIONS:
No individual test can both rule in and rule out injury of the ankle syndesmosis accurately.
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Optimal diagnostic approach:
Initial clustering of tests with high sensitivity (palpation; dorsiflexion lunge).
Followed by a test with high specificity (squeeze).
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These tests cannot definitively diagnose stable vs unstable.
Decisions on conservative vs surgical management require additional imaging or arthroscopy.

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SOURCE:
Netterstr€om-Wedin, 2021. Diagnostic accuracy of clinical tests assessing ligamentous injury ofthe ankle syndesmosis: PT in Sport, (49), pp. 214-226.

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