Diagnostic strategies for chronic lateral ankle instability: a narrative review

Background and Objective: Diagnosing chronic lateral ankle instability (CLAI) involves a comprehensive evaluation encompassing medical history, physical findings, and imaging examination. The optimal method of diagnosis of CLAI remains controversial. Therefore, the objective of this review was to summarize the current literatures regarding recent evolution and technical improvement of diagnostic methods for CLAI. Methods: A literature regarding the diagnosis of CLAI was reviewed on PubMed, including articles written in English until May 2024. Key Content and Findings: In the manual examination for the diagnosis of CLAI, the anterior drawer test is the standard evaluation for lateral ligament insufficiency. The anterolateral drawer test, meanwhile, which focuses more on lateral instability biomechanically, has also been performed. Ultrasonography is a point-of-care tool that is less invasive than stress radiography and can dynamically assess ligament integrity, making the diagnosis of CLAI more accurate and convenient. Magnetic resonance imaging (MRI) is a useful modality that allows extensive preoperative evaluation of ligamentous properties and associated osteochondral damage, and it is essential in the preoperative diagnosis of CLAI. Conclusions: A combination of physical examination and imaging studies is especially important to more accurately diagnose CLAI. Future research should focus on standardizing testing and measurement methods to objectively define CLAI.