Diagnostic accuracy of clinical tests assessing ligamentous injury of the ankle syndesmosis: a systematic review with meta-analysis

Fredh Netterström-Wedin F,, C M Bleakley

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Abstract

Objective: To summarise and evaluate research on the diagnostic accuracy of clinical tests for ligamentous injury of the ankle syndesmosis.

Methods: CINAHL, Embase, and MEDLINE were searched from inception to 12 February 2021. Studies comparing clinical examination to arthroscopy, magnetic resonance imaging, or ultrasound were considered eligible. Meta-analysis was based on random effect modelling and limited to studies fulfilling all QUADAS-2 criteria. Sensitivity (SN), specificity (SP) and likelihood ratios determined diagnostic accuracy, all with 95% confidence intervals (CI).

Results: Six studies were included (512 participants; 13 clinical tests; 29% median prevalence). No individual test was associated with both high sensitivity and high specificity.Tests with the highest sensitivity were: palpation [SN 92% (95%CI 79–98)] and dorsiflexion lunge [SN 75% (95% CI 64–84%); n=2 studies]. Tests with the highest specificity were: squeeze test [SP 85% (95% CI 81–89%); n=4 studies] and external rotation [SP 78% (95% CI 73–82%); n=4 studies].

Conclusions: Clinical examination should involve initial clustering of tests with high sensitivity (palpation; dorsiflexion lunge), followed by a test with high specificity (squeeze). However, as these tests cannot definitively stratify syndesmotic injuries into stable vs unstable, decisions on optimal management (conservative vs surgery) require additional imaging or arthroscopy.
Original languageEnglish
Pages (from-to)214-226
JournalPhysical Therapy in Sport
Volume49
Early online date20 Mar 2021
DOIs
Publication statusE-pub ahead of print - 20 Mar 2021

Keywords

  • Diagnostic accuracy
  • ankle syndesmosis
  • high ankle sprain
  • clinical examination

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