Anterior Drawer Test of the Knee: Difference between revisions

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== Purpose<br>  ==


To test the integrity of the anterior cruciate ligament (ACL)
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== Technique<br> ==
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The patient is supine and the knee to be tested is flexed to approximately 90 degrees. The examiner then sits on the toes of the tested extremity to help stabilize it. The examiner grasps the proximal lower leg, approximately at the tibial plateau or joint line, and attempts to translate the lower leg anteriorly. The test is considered positive if there is a lack of end feel or excessive anterior translation.<ref name="Flynn, Cleland and Whitman">Flynn TW, Cleland JA, Whitman JM.  Users' guide to the musculoskeletal examination: fundamentals for the evidence-based clinician.  United States: Evidence in Motion; 2008.</ref><br>  
== Purpose<br> ==


{{#ev:youtube|yQdBrr3Mmj0}} <ref>Anterior drawer test - knee. As seen on youtube: http://www.youtube.com/watch?v=yQdBrr3Mmj0</ref>
The ‘anterior drawer’s test’ is a test that provokes a possible ACL-tear. If the ‘anterior drawer’s test’ is positive, an additional test such as the ‘pivot-shift’ test or the ‘Lachman’ test can be performed. These tests have a higher predictive value. (1)<br>


== Evidence<br>  ==
== Technique<br>  ==


One source reports sensitivity and specificity as .41-.91 and .86-1.0 respectively, with a -LR of .09-.62 and a +LR of 5.4-8.2.<ref name="Flynn, Cleland and Whitman">Flynn TW, Cleland JA, Whitman JM.  Users' guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician.  United States: Evidence in Motion; 2008.</ref>&nbsp; However, a recent meta-analysis reports the sensitivity and specificity as .18-.92 and .78-.98 respectively.<ref name="Scholten et al">Scholten PJPM, Opstelten W, van der Plas CG, Bijl D, Deville WLJM and Bouter LM.  Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis.  J Fam Pract. 2003;52:689-694.</ref>&nbsp; Scholten et al concluded that based on predictive value statistics, strong conclusions could not be made regarding whether the anterior drawer test was good to rule in or rule out the presence of an ACL tear.<ref name="Scholten et al">Scholten RJPM, Opstelten W, van der Plas CG, Bijl D, Deville WLJM, Bouter LM. Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis. J Fam Pract. 2003;52:689–694.</ref>&nbsp; Other recent research has identified the anterior drawer test as a more effective test to identify chronic conditions, with a sensitivity and specificity of .92 and .91.<ref name="Bejaminse, Gokeler and van der Schans">Benjaminse A, Gokeler A van der Schans CP.  Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis.  J Orthop Sports Phys Ther.  2006;36(5):267-88.</ref>
Describe how to carry out this assessment technique here


The laxity of the ACL or the instability of the knee depends on the forces applied to the knee and increases with higher force. These are different in clinical investigation and during moderate or strenuous activity. Therefor the Anterior drawer test can't always predict the loss of the ACL or the joint instability that exists during strenuous activity. Joint laxity can be reduced when, after injury, a person reduces his or her level of activity. Thus the functional stability can be maintained. <ref>BUTLER DL, NOYES DR, GROOD ES, Ligamentous restraints to anterior-posterior drawer in the human knee. a biomechanical study, J Bone Joint Srug Am. 1980;62:259-270</ref>
== Evidence  ==


Tests that are more likely to give an accurate result are the [[Pivot Shift|pivot shift]] or the [[Lachman Test|Lachman]] <ref>OSTROWSKI JA, Accuracy of 3 diagnostic tests for anterior cruciate ligament tears, Journal of Athletic Training, 2006, 41(1): 120-122</ref>
Provide the evidence for this technique here


== Resources  ==
== Resources  ==


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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==


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== References<br>  ==
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== References ==


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Revision as of 00:24, 26 May 2011

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Purpose
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The ‘anterior drawer’s test’ is a test that provokes a possible ACL-tear. If the ‘anterior drawer’s test’ is positive, an additional test such as the ‘pivot-shift’ test or the ‘Lachman’ test can be performed. These tests have a higher predictive value. (1)

Technique
[edit | edit source]

Describe how to carry out this assessment technique here

Evidence[edit | edit source]

Provide the evidence for this technique here

Resources[edit | edit source]

add any relevant resources here

References
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The content on or accessible through Physiopedia is for informational purposes only. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Read more.
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