Clinical Question: In patients with acute knee injuries, is there evidence to support that the lever sign test is more accurate in diagnosing an anterior cruciate ligament sprain than the Lachman test? Clinical Bottom Line: The evidence does not indicate that the lever sign test can be used in isolation in lieu of the Lachman test, but there is sufficient evidence to support adding the lever sign test to the examination of potential anterior cruciate ligament sprains.

The purpose of this study was to compare gluteus maximus (GM) corticomotor excitability between individuals with and without chronic ankle instability (CAI) and examine associations between GM excitability and clinical outcomes. We recruited 30 participants (F:20, M:10, 22.8 ± 2.6 years, 169.4 ± 7.9 cm, 68.7 ± 12.4 kg) classified as CAI, copers (COP), or controls (CON). We measured active motor threshold (AMT) and motor evoked potential (MEP) of the GM. We also assessed star excursion balance test (SEBT) performance and the Foot and Ankle Ability Measure (FAAM). One-way ANOVAs tested group differences in outcomes. Associations between outcomes were tested with Pearson's product moment correlations. CAI did not differ in AMT compared to CON (P = .14) or COP (P = .19). COP had an increased AMT compared to CON (P = .04, d = 1.77 [0.31, 2.96]). CAI had lower SEBT anterior (P = .03, d = −1.33 [−2.24, −0.31]), posterolateral (P = .02, d = −1.59 [−2.51, −0.52]), posteromedial (P = .02, d = −1.44 [−2.36, −0.41]), and composite (P < .01, d = −1.94 [0.53, −2.90]) compared to COP. CAI had lower FAAM-ADL and FAAM-Sport scores than COP and CON. There was a small correlation between AMT and SEBT composite (r = .47, P = .04). Individuals with CAI did not differ in GM excitability compared to individuals without CAI. Copers' reduced excitability suggests they possess unique central nervous system adaptations after sustaining an ankle sprain.