Table 3.
Diagnostic accuracy of six syndesmosis tests and clinical suspicion for injury of the syndesmosis ligaments in 150 athletes with an acute ankle injury. MR imaging was used as reference standard
| Positive findings | Sensitivity % | Specificity % | LR+ | LR− | PPV % | NPV % | AUC | |
|---|---|---|---|---|---|---|---|---|
| Syndesmosis tests | ||||||||
| Tenderness AITFL | 78/150 (0.52) | 58 (37–76) | 49 (40–58) | 1.14 (0.78–1.65) | 0.86 (0.54–1.37) | 19 (12–30) | 85 (74–92) | 0.52 (0.43–0.61) |
| Squeeze test | 38/150 (0.25) | 46 (27–66) | 79 (71–86) | 2.20 (1.29–3.77) | 0.68 (0.48–0.98) | 32 (18–49) | 88 (80–93) | 0.60 (0.49–0.71) |
| NWB DF ER test | 74/148 (0.50) | 58 (37–76) | 52 (42–61) | 1.19 (0.82–1.74) | 0.82 (0.52–1.30) | 20 (12–32) | 85 (75–92) | 0.53 (0.44–0.62) |
| WB DF ER test | 99/149 (0.66) | 69 (48–85) | 34 (26–43) | 1.05 (0.79–1.40) | 0.90 (0.49–1.65) | 18 (11–27) | 84 (70–92) | 0.51 (0.42–0.61) |
| Fibular translation test | 26/147 (0.18) | 15 (5–36) | 82 (74–88) | 0.85 (0.32–2.25) | 1.03 (0.87–1.22) | 15 (5–36) | 82 (74–88) | 0.49 (0.37–0.61) |
| Cotton test | 21/139 (0.15) | 27 (12–48) | 88 (80–93) | 2.17 (0.98–4.84) | 0.83 (0.66–1.06) | 33 (15–57) | 84 (76–90) | 0.59 (0.45–0.73) |
| All tests negative | 35/147 (0.23) | 23 (10–44) | 76 (67–83) | 0.96 (0.45–2.08) | 1.01 (0.82–1.26) | 17 (7–34) | 82 (74–88) | 0.50 (0.37–0.62) |
| Clinical suspicion | ||||||||
| Syndesmosis injury | 79/143 (0.55) | 73 (52–88) | 49 (39–58) | 1.43 (1.06–1.91) | 0.55 (0.29–1.06) | 24 (15–35) | 89 (78–95) | 0.61 (0.49–0.73) |
The prevalence of acute syndesmosis injuries and the diagnostic values of six syndesmosis tests (including the combination of these six tests) and clinical suspicion are presented. All values are presented with 95% confidence interval (95% CI); positive likelihood ratio (LR +); negative likelihood ratio (LR-); positive predictive value (PPV); negative predictive value (NPV)