CLINICAL-TESTS FOR ANKLE SYNDESMOSIS INJURY - RELIABILITY AND PREDICTION OF RETURN TO FUNCTION

Despite the severity of ankle syndesmosis injuries, it has been argued that they are relatively poorly detected. This study investigated the interrater reliability of four orthopaedic tests for ankle syndesmosi s injury and assessed their ability to predict the extended recovery t imes that have been reported as a consequence oi this injury. Nine phy siotherapists, working in random pairings, examined 53 subjects, all r eceiving treatment for ankle injury at two private clinics. Each subje ct was tested by two physiotherapists who independently performed the palpation test, external rotation test, squeeze lest, and dorsiflexion -compression test Kappa coefficient testing indicated that the externa l rotation test had the best interrater reliability (kappa = 0.75). Th e squeeze test was found to have moderate reliability (kappa = 0.50), and the palpation and dorsiflexion-compression tests both had only fai r reliability (kappa = 0.36). The degree of pair-wise association betw een the results of the four tests was low (phi less than or equal to 0 .30 for all test combinations), suggesting that ii all four tests were performed on the same subject, it was not likely that they would achi eve similar results. Follow-up interviews were conducted to determine the time taken for subjects to walk 10 m without pain and, for sports injuries, the time taken to return to training and then to competition . For each test, Mann-Whitney U values showed no significant differenc e between the recovery times of subjects with positive or negative tes t results, although subjects with recovery times markedly longer than normal were detected by three of the four tests. When an either/or com bination of the external rotation and dorsiflexion-compression tests w as considered, subjects with a positive test result look significantly longer to return to playing sports.