Examination Tests

Question 1

Anterior Drawer Test

Answer 1

• This test demonstrates an excessive anterior translation of the tibia on the femur.
• Involves knee flexion to 90° whilst performing test.
• Foot must be stabilised in NEUTRAL (not IR or ER) to prevent testing posterolateral / posteromedial complexes.
• Less sensitive than lachmans test.
• Graded according to AMOUNT OF ANTERIOR TRANSLATION and PRESENCE / ABSENCE OF ENDPOINT.

Mainly tests AM bundle

Question 2

Lachmann Test

Answer 2

• Introduced by TORG (AJSM 1976).
• This test has the highest SENSITIVITY (95%) for ACL ruptures.
• Performed with knee flexed to 30°, with attempted ANTERIORISATION of the tibia on the femur.
• Graded based on EXCESSIVE ANTERIOR TRANSLATION and PRESENCE / ABSENCE OF ENDPOINT.
• Laxity associated with a positive endpoint in a chronic ACL tear suggests ACL HEALING onto PCL.
• This tests the AM bundle.

Question 3

Pivot Shift Test

Answer 3

• Introduced by MACKINTOSH.
• Pivot shift test requires an INTACT MCL & ITB.
• Pivot shift test demonstrates subluxation & reduction of tibia in ACL incompetent knees.
• This is pathognomonic for a non-functioning ACL.
• In extension, the tibia is subluxed anterior to the femur.
• With valgus / IR / flexion forces, the tibia reduces at 20-30° of flexion as the ITB MOVES POSTERIOR TO THE KNEE COR, thus reducing the tibia on femur.
• May be graded as NORMAL, GLIDE or SHIFT.