Luan Lijiang, Ji Wenxuan, Ganderton Charlotte, Farragher Joshua, Pappas Evangelos, Adams Roger David, Wang Shasha, Han Jia
Jiangwan Hospital of Hongkou District, Shanghai, China.
School of Physical Education and Health, Sanming University, Sanming, China.
Front Bioeng Biotechnol. 2025 Sep 9;13:1664779. doi: 10.3389/fbioe.2025.1664779. eCollection 2025.
The anterior drawer test (ADT) has been widely used in assessing mechanical ankle instability (MAI), yet its applicability has been questioned. This study aims to clarify the clinical value of the ADT. Five databases were searched in January 2025. Studies investigating the properties of the ADT were included. Data on reliability, validity, diagnostic accuracy, and responsiveness were extracted. A total of 424 studies were screened, and 45 studies were included. The ADT generally demonstrated good to excellent intra-rater reliability, but relatively poor inter-rater reliability. Criterion validity was supported by moderate to strong correlations with imaging and anatomical measurements. The diagnostic accuracy of ADT and its variants, such as the anterolateral and reverse ADTs, showed to be generally favorable. Inconsistencies in responsiveness across studies highlighted the need for population-specific classifications and the urgent establishment of corresponding measurement standards. The manual ADT exhibited a minimal detectable change value of 1.995 mm for intra-rater reliability. Overall, the ADT provides valuable insights for diagnosing MAI, but its inter-rater reliability and accuracy may be influenced by examiners' clinical experience and testing methods. Standardized protocols and advanced grading systems are needed to minimize inter-rater variability and enhance its result consistency, precision, and clinical utility.
前抽屉试验（ADT）已被广泛用于评估踝关节机械性不稳定（MAI），但其适用性一直受到质疑。本研究旨在阐明ADT的临床价值。2025年1月检索了五个数据库。纳入了研究ADT特性的研究。提取了关于可靠性、有效性、诊断准确性和反应性的数据。共筛选了424项研究，纳入45项研究。ADT通常表现出良好至优秀的评分者内信度，但评分者间信度相对较差。与影像学和解剖学测量的中度至强相关性支持了标准效度。ADT及其变体（如前外侧ADT和反向ADT）的诊断准确性总体上表现良好。各研究中反应性的不一致突出了针对特定人群进行分类的必要性以及迫切需要建立相应的测量标准。手动ADT在评分者内信度方面的最小可检测变化值为1.995毫米。总体而言，ADT为诊断MAI提供了有价值的见解，但其评分者间信度和准确性可能受检查者临床经验和检测方法的影响。需要标准化方案和先进的分级系统，以尽量减少评分者间的变异性，并提高其结果的一致性、精确性和临床实用性。
