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Lack of Definition of Chronic Ankle Instability With Arthrometer-Assisted Ankle Joint Stress Testing: A Systematic Review of In Vivo Studies

  • Francisco Guerra-Pinto
    Correspondence
    Address correspondence to: Francisco Guerra-Pinto, MD, FEBOT, Estrada da Ribeira 838, Alcabideche 2645-575, Portugal.
    Affiliations
    NOVA Medical School, Lisbon NOVA University, Lisbon, Portugal

    Hospital da Cruz Vermelha, Lisbon, Portugal

    Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain, Portugal

    Department of Orthopaedic Surgery, Hospital de Sant'Ana, Parede, Portugal
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  • Renato Andrade
    Affiliations
    Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal

    Dom Henrique Research Centre, Porto, Portugal

    Faculty of Sports, University of Porto, Porto, Portugal
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  • Pedro Diniz
    Affiliations
    Department of Orthopaedic Surgery, Hospital de Sant'Ana, Parede, Portugal

    Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal

    Human Performance Department, Sport Lisboa e Benfica, Lisboa, Portugal

    Fisiogaspar, Lisboa, Portugal
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  • Ana Luisa Neto
    Affiliations
    Department of Orthopaedic Surgery, Hospital de Sant'Ana, Parede, Portugal
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  • João Espregueira-Mendes
    Affiliations
    Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal

    Dom Henrique Research Centre, Porto, Portugal

    ICVS/3B's–PT Government Associate Laboratory, Braga, Guimarães, Portugal

    School of Medicine, University of Minho, Braga, Portugal
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  • José Guimarães Consciência
    Affiliations
    NOVA Medical School, Lisbon NOVA University, Lisbon, Portugal

    Director of the Orthpaedic Department at CHLO - S F Xavier Central Hospital, Lisbon, Portugal
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      Abstract

      Despite extensive research on ankle instability a consensual and clear objective definition for pathological mechanical lateral ankle instability is yet to be determined. This systematic review aimed to summarize current available arthrometric devices, measuring methods and lateral ankle laxity outcomes in patients with chronic ankle instability that underwent objective arthrometric stress measurement. Sixty-eight studies comprising a total of 3,235 ankles with chronic ankle instability were included. Studies reported a wide range of arthrometric devices, testing position and procedures, and measuring methods. For the anterior drawer test, the average mean differences between injured and uninjured ankles ranged from -0.9 to 4.1 mm, and total translation in the injured ankle from 3.2 to 21.0 mm. Most common pathological threshold was ≥4 mm or ≥10 mm unilaterally and ≥3 mm bilaterally. For the talar tilt test, the average mean differences between injured and uninjured ankles ranged from 0.0° to 8.0°, and total tilt from injured ankle from 3.3 to 60.2°. Most common pathological threshold was ≥ 10° unilaterally and ≥ 6° mm bilaterally. It was found high heterogeneity in the scientific literature regarding the arthrometric devices, use of concomitant imaging and measuring methods of arthrometer-assisted anterior drawer and talar tilt tests which led to variable laxity outcomes in individuals with chronic ankle instability. Future studies should focus on standardizing the testing and measuring methods for an objective definition of mechanical ankle instability.

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