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.