Utilizing an apparatus for separately testing the status of the anterior talofibular and the calaneofibular ligaments of the ankle in 25 healthy, 15- to 30-year-old adults, it became apparent that the stability of the ankle depends primarily upon the integrity of the anterior talofibular ligament. When the "fore n' aft" stress measurement exceeds 4 mm, a positive anterior drawer test is elicited, and the ankle ligament needs surgical repair. Tibial talar tilt normals ranged up to 18 degrees. Repair (early and late) is accomplished by suturing what one finds (there is always some ligament present) and reinforcing the anterior talofibular ligament repair with overlap of the nearby lateral talocalcaneal ligament plus the marginal ankle retinaculum. Four weeks in a plaster of paris walking cast are followed by use of Ace bandages of 2 weeks. Light activity is begun 6 weeks after repair, and activity of choice is begun 8 weeks after repair. Repeat stress testing is performed at 3 months postsurgery, and a questionnaire is completed at the same time. On a point system (1 to 10) reviewing pain, stability, and swelling, the results in 50 cases rate from 8 to 10, with a lower rating improving with more time. Surgical time is approximately 30 minutes. There seems to be no need for more radical surgery utilizing other muscles. The senior author has employed this surgery for the past 19 years with approximately 165 cases. Only 50 patients with proper 3-month postoperative stress testing and questionnaire follow-up, who were operated upon 1 or more years ago, area recorded here.

Bilateral ankle stress testing was performed on 25 subjects in a device which controlled position of the foot and the amount of force applied during the examination. Both inversion testing in the anteroposterior plane and anterior drawer testing in the lateral plane were performed in the same group of symptom-free patients. The reproducibility of the test was demonstrated. Previous history of injury, left vs. right handedness, side and anthropometric measurements did not affect the test. There was no difference in the inversion test between ankles tested in neutral and plantar flexion. In functionally normal ankles, the range of inversion "talar tilt" was 0 to 18 degrees while the maximum of anterior displacement on drawer testing was 3 mm. The effective stiffness of the anterior talofibular ligament was thus computed as 65 +/- 34 N/m. Anterior drawer testing appears to evaluate lateral ligamentous integrity of the ankle more critically than the talar tilt test.

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