Anterior Drawer Test (Ankle): How to Check for ATFL Tear

The Anterior Drawer Test of the ankle is the primary orthopedic special test used to assess the integrity of the Anterior Talo-Fibular Ligament (ATFL) following a lateral ankle sprain.

1. Purpose

The primary purpose of the Anterior Drawer Test for the ankle is to **test for** the integrity of the Anterior Talo-Fibular Ligament (ATFL). This is the most commonly injured ligament in a lateral ankle sprain (inversion injury).

2. How to Perform

1. The patient is positioned in supine with the knee slightly flexed to relax the gastrocnemius muscle.
2. The examiner stabilizes the distal tibia and fibula (lower leg) with one hand.
3. The examiner grasps the patient's calcaneus (heel) with the other hand.
4. The ankle is placed in about 20 degrees of plantarflexion.
5. The examiner applies an anterior (forward) force to the heel, attempting to pull the talus forward out of the ankle mortise.

3. Positive & Negative Sign

Positive Sign (Test is POSITIVE):
A positive test (indicating an ATFL tear) is:

• Excessive anterior translation (forward movement) of the talus compared to the uninjured side.
• A "dimple" or "suction sign" may appear on the anterolateral aspect of the ankle.
• A "clunk" may be felt or heard.

Negative Sign (Test is NEGATIVE):
A negative test is a firm end-feel with minimal forward movement.