Anterior Drawer Test to Assess ACL Injuries

This test has a sensitivity of 92% and a specificity of 91%, according to a meta-analysis done by Benjaminse et al. (2006). These values are reported for a chronic situation, while the test performs way poorer in an acute situation.

Before you perform the test, it is first recommended to exclude a posterior cruciate ligament (PCL) injury in order to avoid false-positive results.

To perform the anterior drawer test bring your patient’s hip to 45 and your patient’s knee to 90 degrees of flexion. You can fixate this position by gently sitting on the foot of your patient. Then palpate the joint line with your thumbs, and try to move the tibia anteriorly in an explosive movement. This test is positive if the tibia translates anteriorly more than six millimeters or if you experience a soft and mushy end feel.

Other common orthopedic tests to assess for ACL ruptures are:

• Lachman Test
• Lateral Pivot-Shift Test
• Lelli Test/Lever Sign

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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References

Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2006 May;36(5):267-88.

van Eck, C. F., van den Bekerom, M. P., Fu, F. H., Poolman, R. W., & Kerkhoffs, G. M. (2013). Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Knee Surgery, Sports Traumatology, Arthroscopy, 21(8), 1895-1903.

Huang, W., Zhang, Y., Yao, Z., & Ma, L. (2016). Clinical examination of anterior cruciate ligament rupture: a systematic review and meta-analysis. Acta Orthop Traumatol Turc, 50(1), 22-31.

Peeler, J., Leiter, J., & MacDonald, P. (2010). Accuracy and reliability of anterior cruciate ligament clinical examination in a multidisciplinary sports medicine setting. Clinical journal of sport medicine, 20(2), 80-85.