Abstract
Two test devices were manufactured to objectively measure ankle joint laxity: the dynamic anterior ankle tester (DAAT) and the quasi-static anterior ankle tester (QAAT). The primary aim was to analyse the reliability of both testers; The secondary aim was to assess validity in correlation with TELOS stress test and manual anterior drawer test. Twenty-four normal subjects and 14 patients 1 year after acute lateral ankle ligament injury were included. Both ankles were tested with the DAAT and QAAT by two different observers; one experienced orthopaedic surgeon performed the manual test; the TELOS stress X-rays were evaluated by one observer. Intra observer reliability for the DAAT varied between 0.81 and 0.94; for the QAAT between 0.71 and 0.94. Inter observer reliability for the DAAT varied between 0.84 and 0.94; for the QAAT between 0.76 and 0.82. Concurrent validity showed fair correlation between DAAT and QAAT for the first couple observers (0.71); however, a poor correlation was observed for the second couple (0.42). No significant correlations were found between neither DAAT and the TELOS and the manual test, nor QAAT and the TELOS and the manual test. In conclusion, reliability of both testers is high. Validity of the testers needs further investigation.
Similar content being viewed by others
References
Ahuvuo J, Kaartinen E, Slätis P (1988) Diagnostic value of stress radiography in lesions of the lateral ligaments of the ankle. Acta Radiol 29:711–714
Allinger TL, Engsberg JR (1993) A method to determine the range of motion of the ankle joint complex, in vivo. J Biomech 26:69–76
Almquist PO, Arnbjörnsson A, Zätterström R, Ryd L, Ekdahl C, Fridèn T (2002) Evaluation of an external device measuring knee joint rotation: an in vivo study with simultaneous Roentgen stereometric analysis. J Orthop Res 20:427–432
Consumer Safety Institute (2004) [The Dutch Injury Surveillance System: ankle injuries]. Personal communication
Daniel DM, Stone ML, Sachs R, Malcom LL (1985) Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 13:401–407
Freeman MAR, Wyke B (1967) Articular reflexes at the ankle joint. An electromyographic study of normal and abnormal influences of the ankle joint mechanoreceptors upon reflex activity in the leg muscles. Br J Surg 54:990–1001
Fujii T, Luo Z-P, Kitoaka HB, An K-N (2000) The manual stress test may not be sufficient to differentiate ankle ligament injuries. Clin Biomech 15:619–623
Gottlieb GL, Agarwal GC (1979) Response to sudden torques about ankle in man. J Neurophysiol 42:91–106
Karlsson J (1989) Chronic lateral instability of the ankle joint: a clinical, radiological and experimental study. Thesis, University of Gothenburg
Karlsson J, Bergsten T, Peterson L, Zachrisson BE (1991) Radiographic evaluation of ankle joint stability. Clin J Sports Med 1:166–171
Kerkhoffs GM, Blankevoort L, Schreurs AW, Jaspers JE, Van Dijk CN (2002) An instrumented, dynamic test for anterior laxity of the ankle joint complex. J Biomech 35:1665–1670
Kerkhoffs GM, Blankevoort L, Van Dijk CN (2005). A measurement device for anterior laxity of the ankle joint complex. Clin Biomechanics 20:219–222
Kerkhoffs GM, Blankevoort L, Van Poll D, Marti RK, Van Dijk CN (2001) Anterior lateral ankle ligament damage and anterior talocrural-joint laxity: an overview of the in vitro reports in literature. Clin Biomech 16:635–643
Klenerman L (1998) (eds) The management of sprained ankle. J Bone Joint Surg [Br] 80-B:11–12
Lindstrand L (1976) Lateral lesions in sprained ankles. A clinical and roentgenological study with special reference to anterior instability of the talus. Thesis, University of Lund
Sauser DC, Nelson CN, Lavine MH, Wu CW (1983) Acute injuries of the lateral ligaments of the ankle: comparison of stress radiography and arthrography. Radiology 148:653–657
Shrout PE, Fleiss JL (1979) Intra-class correlations: uses in assessing rater reliability. Psychol Bull 86:420–428
Stormont DM, Morrey BF, Cass JR (1985) Stability of the loaded ankle, relation between articular restraint and primary and secondary static restraints. Am J Sports Med 13:295–300
Tohyama H, Yasuda K, Ohkoshi Y, Beynnon BD, Renström PA (2003) Anterior drawer test for acute anterior talofibular ligament injuries of the ankle. How much load should be applied during the test? Am J Sports Med 31:226–232
Van Dijk CN, Mol BW, Lim LSL, Marti RK, Bossuyt PM (1996) Diagnosis of ligament rupture of the ankle joint. Acta Orthop Scand 67:566–570
Verhagen RA, De Keizer G, Van Dijk CN (1995) Long-term follow-up of inversion trauma of the ankle. Arch Ortop Trauma Surg 114:92–96
Wiersma PH (1998) Dynamic loading of the lateral ankle ligament complex: an experimental, clinical and anatomical study. Thesis, University of Amsterdam
Acknowledgements
The development of a diagnostic and post-therapy evaluation test-device is supported by Biomet B.V., Zwijndrecht, The Netherlands.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kerkhoffs, G.M., Blankevoort, L., Sierevelt, I.N. et al. Two ankle joint laxity testers: reliability and validity. Knee Surg Sports Traumatol Arthrosc 13, 699–705 (2005). https://doi.org/10.1007/s00167-005-0644-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-005-0644-7