Diagnostic accuracy of instrumented and manual talar tilt tests in chronic ankle instability populations

Abstract

Diagnostic accuracy of the talar tilt test is not well established in a chronic ankle instability (CAI) population. Our purpose was to determine the diagnostic accuracy of instrumented and manual talar tilt tests in a group with varied ankle injury history compared with a reference standard of self-report questionnaire. Ninety-three individuals participated, with analysis occurring on 88 (39 CAI, 17 ankle sprain copers, and 32 healthy controls). Participants completed the Cumberland Ankle Instability Tool, arthrometer inversion talar tilt tests (LTT), and manual medial talar tilt stress tests (MTT). The ability to determine CAI status using the LTT and MTT compared with a reference standard was performed. The sensitivity (95% confidence intervals) of LTT and MTT was low [LTT = 0.36 (0.23-0.52), MTT = 0.49 (0.34-0.64)]. Specificity was good to excellent (LTT: 0.72-0.94; MTT: 0.78-0.88). Positive likelihood ratio (+ LR) values for LTT were 1.26-6.10 and for MTT were 2.23-4.14. Negative LR for LTT were 0.68-0.89 and for MTT were 0.58-0.66. Diagnostic odds ratios ranged from 1.43 to 8.96. Both clinical and arthrometer laxity testing appear to have poor overall diagnostic value for evaluating CAI as stand-alone measures. Laxity testing to assess CAI may only be useful to rule in the condition.

In vivo arthrometer measurements of mechanical ankle instability—A systematic review

“…The values for the degree of inversion in CAI patients ranged from 4.8 ± 3.4° in an MRI measurement to 35.7 ± 6.1° for the Hollis arthrometer . Ten studies reported an increase in inversion ROM, while one study reported a decrease in total ROM compared to a healthy contralateral ankle in unilateral CAI . However, only four of the ten studies reported a statistically significant increase .…”

“…However, 13 of the 33 studies did not use a questionnaire nor any other form of quantifying the amount of functional impairment. Eleven studies used manual testing, two used additional stress radiographs and one used stress radiographs only, another study used stress sonography and one used plain radiographs as a reference standard.…”

“…In summary, there were six devices measuring inversion–eversion, of these only one device reported validity in terms of specificity and sensitivity . Other devices inferred a certain degree of validity from in vitro cadaver experiments .…”

“…In the clinical setting, the evaluation of MAI is performed using the anterior drawer, anterolateral drawer, and talar tilt test . The accuracy of any clinical test is dependent on the examiner's experience and cannot serve as a reliable tool in research …”

An Extensive Evaluation of Different Knee Stability Assessment Measures: A Systematic Review

“…Similar to others used in the hip [76], ankle [77] and hamstring injuries [78], the existing tests for knee stability assessment are deficient in relation to diagnosis, surgical outcome assessment and clinical decisions on return-to-play following injury or surgery.…”