Stemcelldoc's Weblog

April 30, 2012

Ankle Anterior Draw Sign: Assessing the stability of the Anterior Talofibular Ligament

Stability is a central theme at the Centeno-Schultz Clinic as discussed in Ortho 2.0.

The anterior talofibular ligament provides critical lateral support to the ankle and has been discussed in prior blogs.

Stability of the anterior talofibular ligament is evaluated by the anterior draw sign whereby the distal part of the leg is stabilized with one hand while the other hand cups the heel.  An anterior pull is applied to the heel attempting to move the talus forward from beneath the tibia.

The anterior drawer test has demonstrated high accuracy in the determination of lateral ankle instability and in the diagnosis of a ligament rupture.

Stem cell therapy is an alternative to traditional ankle surgery and a clinical case has been previously discussed.

At the Centeno-Schultz Clinic the anterior drawer sign can be performed under MSK ultrasound which can distinguish a partial from a complete tear.  The patient is place in the prone position with the foot hanging off the exam table in plantar flexion.  The forefoot is then pulled forward while the tibia is stabilized.  If the ATF is torn the gap between the talus and the tibia/fibula will widen when anterior force is applied which is depicted below.

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