A positive anterior drawer test of the ankle most directly assesses which ligament?

• A. Deltoid
• B. Calcaneofibular
• C. Posterior talofibular
• D. Anterior talofibular

Answer: (D)

The test is designed to stress the ligament that resists forward movement of the talus under the ankle mortise. When you perform it with the foot in slight plantarflexion, you translate the talus anteriorly relative to the tibia and fibula. If the anterior talofibular ligament is torn or lax, the talus moves forward more than normal and the end feel is soft, giving a positive result. This ligament is the primary restraint against anterior displacement after an inversion sprain, which is why this test most directly assesses it. Other ligaments are tested with different maneuvers—posterior translation targets the posterior talofibular ligament, inversion in various positions stresses the calcaneofibular ligament, and eversion stresses the deltoid—so the anterior drawer specifically points to the ATFL.