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Impact of the educational workshop on the manual anterolateral drawer test: A cadaveric study
Hirofumi Nakajima1, Satoshi Yamaguchi2, Seiji Kimura1
1Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan.
Background:
The manual anterolateral drawer test (ALDT) is used to assess ankle instability, but performing the maneuver correctly is challenging, especially for inexperienced clinicians. An effective training strategy to learn the technique is required. This study aimed to determine whether a structured training workshop for inexperienced physicians improves ankle kinematics during the ALDT and the assessment of ankle instability in cadaveric ankles.
Methods:
Twenty senior orthopedic residents performed ALDT on intact, anterior tibiofibular ligament (ATFL)-cut, and ATFL/calcaneofibular ligament (CFL)-cut ankles. Three-dimensional ankle kinematics were measured using infrared markers, with ATFL length changes as the primary outcome. The examiners also assessed ankle instability in three grades. The senior physicians first performed the ALDT using their individual methods. Afterward, a 1-h educational workshop was held using a document, video, and hands-on session. Finally, the examiners performed ALDT again on the same three ankles. The ATFL length changes during the ALDT were compared before and after the workshop using paired t-tests. The ankle instability assessments by the examiners were compared using Chi-square tests.
Results:
Before the workshop, the ATFL length changes were 2.6 ± 0.9 mm, 7.5 ± 3.5 mm, and 6.2 ± 2.7 mm in the intact, ATFL-cut, and ATFL/CFL-cut ankles, respectively. The length changes significantly increased to 3.2 ± 1.2 mm (p = 0.04), 10.0 ± 2.4 mm (p = 0.005), and 8.5 ± 2.2 mm (p = 0.005) after the workshop. Before the workshop, 9 (45%), 7 (35%), and 7 (35%) examiners assessed ankle instability correctly for the intact, ATFL-cut, and ATFL/CFL-cut ankles, respectively. The number of examiners with correct assessments did not increase in all ankles after the workshop (p = 0.34-0.75).
Conclusions:
The training workshop for inexperienced examiners increased ATFL lengths during the ALDT maneuver. However, it did not improve ankle instability assessment.
