Lachman Test for ACL tears

The Lachman test is also known under the name of Ritchie, Trillat or Lachman Trillat test and it is described as the most valid test by a meta-analysis by Benjaminse et al. (2006) with a sensitivity of 85% and a specificity of 94%

Experts recommend first excluding a PCL injury before you conduct the test for an ACL tear. The reason for this is that the tibia sags posteriorly with a PCL injury which could give you the impression that there is a lot of movement of the Tibia when you conduct an ACL test so you could have a false positive in the end

To perform this test have your patient in supine line position and bring your patient’s test leg into 30 degrees of flexion. Fixate the femur with your other hand Bring the tibia into slight external rotation and then try to translate the tibia anteriorly

This test is positive if you experience a soft or mushy end feel or if the anterior.

Translation of the Tibia in the injured leg is at least three millimeters greater compared to the uninjured leg. Remember that your test results in a chronic situation will always be more valid than in an acute situation. The reason for this is that swelling and muscle spasms in an acute situation will have a negative influence on your test results.

Other common orthopedic tests to assess for ACL tears are:

• Anterior Drawer Test
• Lelli Test / Lever Sign
• Lateral Pivot-Shift Test

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.

Lange, T., Freiberg, A., Dröge, P., Lützner, J., Schmitt, J., & Kopkow, C. (2015). The reliability of physical examination tests for the diagnosis of anterior cruciate ligament rupture–a systematic review. Manual therapy, 20(3), 402-411.