Syndesmosis Tests, Ligament Laxity and Concomitant Injuries

Eamonn describes the anterior inferior tibiofibular ligament and the high ankle sprain, with swelling at or above the malleoli as a key sign. Clinicians should suspect a syndesmosis injury when the mechanism involves a fixed externally rotated foot, forced pronation or forced dorsiflexion. Palpation of the ligament is the most sensitive test, while the squeeze test is the most specific, followed by the dorsiflexion external rotation stress test. He demonstrates all three in sequence. He then covers laxity. The anterior drawer test is the most sensitive test for complete rupture of the anterior talofibular ligament and is best performed four to six days after injury; a sulcus sign suggests complete rupture. Complete ruptures carry more than three times the risk of talar bone contusion and a higher risk of deltoid ligament injury. The part closes with the 2018 International Ankle Consortium recommendations, including the reminder that around 15% of inversion injuries involve a fracture.