A systematic review 1 including 8 studies with a total of 950 subjects was abstracted in DARE. 7 case series assessed acute ligamentous damage and one (n=17) assessed chronic ankle instability. For the talar tilt test the authors used 7, 10, and 11 degrees and 3 mm as upper limits of normal. For the anterior displacement test the authors defined 4, 6, and 7 mm as the upper limits of normal and one group defined a positive test as > 1 mm compared with the uninjured ankle. The results from 6 studies gave a sensitivity ranging from 31% to 74%, and a specificity ranging from 0% to 100%. The positive predictive values ranged from 78% to 100% and the negative predictive value from 0% to 100% (the prevalence ranged from 46% to 100%). The likelihood ratio for positive test ranged from 0.74 to 16.5, and the likelihood ratio for a negative test ranged from 0.3 to 0.8. In the series assessing chronic instability, stress radiography was negative in 6 patients who had confirmed tears at surgery and in 3 patients who had normal ligaments at surgery.
Comment: Because the treatment evolution of all acute ankle sprains is towards functional non-operative treatment and because treatment does not depend on the degree of ankle instability on stress views, the talar tilt and anterior displacement, stress X-rays have no clinical relevance in the acute situation. In chronic instability, the results of stress tests are so varied that the tests are not suitable for clinical use.
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