Table 3

Summary of included studies investigating diagnostic accuracy

StudyParticipantsInclusion–exclusion criteriaProceduresTests investigatedReference standard used
Nussbaum et al16N=60 (51M, 9F)
NCAA Division I-A athletes with syndesmosis sprain
34 of 60 injuries in football, 9 lacrosse, 8 soccer, 2 rowing and 1 each in wrestling, gymnastics, swimming, track, field hockey, cheerleading, basketball
Right ankle 28
Left ankle 32

  • History and physical examination consistent with an acute ankle sprain

  • Functional disability by failure on a single leg hop test

  • Evaluated and treated within 24 h of injury

  • No history of prior syndesmosis ankle sprain

Physical examination and standard radiographs including AP, internal rotation mortise and lateral views
Examined within 24 h of injury by certified athletic trainer. Physician reported on radiographs		Squeeze test
Ligament palpation
External rotation stress test with passive dorsiflexion		Radiographs
Beumer et al26N=12
3 Participants with suspected chronic syndesmosis injury underwent arthroscopy
9 healthy subjects with asymptomatic ankles		Not definedParticipants sat behind a curtain with exposure only of the lower legs
Both legs were examined twice in a different order by 7 examiners (4 orthopaedic surgeons, 3 orthopaedic registrars)
Participants did not speak and indicated pain by tapping on a wooden board then pointing to the place where pain was felt
Following day, 3 patients with suspected chronic syndesmosis injury underwent arthroscopy		Squeeze test
Cotton test
Fibula translation
External rotation stress test
Anterior drawer
Dorsiflexion range of motion		Arthroscopy