Anterior Drawer Test of the Knee: Difference between revisions

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'''Original Editor '''- [[User:Roel De Groef|Roel De Groef]]
'''Original Editor '''- Kathryn Schwartzkopf-Phifer<br>


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== Video ==
== Purpose<br>  ==
 
To test the integrity of the anterior cruciate ligament (ACL)(<ref name="Katz and Fingeroth">Katz JW, Fingeroth RJ. The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries. The American Journal of Sports Medicine 1986;14:88-91.fckLRhttp://ajs.sagepub.com/content/14/1/88.short (accessed 18 July 2013).</ref>)
 
== Technique<br> ==


{{#ev:youtube|yQdBrr3Mmj0}}<ref name="bigesor">bigesor. Anterior drawer test - knee. Available from: http://www.youtube.com/watch?v=yQdBrr3Mmj0 [last accessed 18/8/13]</ref>  
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>


To diagnose ruptures of the anterior cruciate liagment (ACL) by testing it's integrity (<ref name="Katz and Fingeroth">Katz JW, Fingeroth RJ. The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries. The American Journal of Sports Medicine 1986;14:88-91.fckLRhttp://ajs.sagepub.com/content/14/1/88.short (accessed 18 July 2013).</ref>).
== 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>


The patient lies supine on a plinth with their hips flexed to 45degrees, thier knees flexed to 90degress and their feet flat on the plinth. The physiotherapist sits on the patients foot (the side to be examined) and with both hands grasps the patients' proximal tibia (just below the tibiofemoral joint line) and pulls it forwards. If the tibia translates forward significantly more than the contralateral side, the test is considered positivie (<ref name="bigesor" />).
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>


<ref name="Katz and Fingeroth" />&nbsp;reported that the knee anterior draw test has a diagnostic accuracy of [[Anterior Cruciate Ligament Injury|acute ACL ruptures]] (within 2 weeks of examination) of: 22.2% sensitivity and &gt;95% specificity.&nbsp;The study reported the diagnostic accuracy of subacute/chronic ACL ruptures (more than 2 weeks before examination) is: 40.9% sensitivity and 98.4% specificity.&nbsp;It is important to note that in this study all examinations were performed under anesthesia; thus the diagnostic accuracy in physiotherapy clinical pracitice may be less.&nbsp;The knee anterior draw test, although widely used, is a poor diagnostic indicator of ACL ruptures, especially in the acute setting (<ref name="Katz and Fingeroth" />).
== Resources  ==


Both the [http://www.physio-pedia.com/Lachman_Test Lachman test] and the [http://www.physio-pedia.com/Pivot_Shift pivot shift test] have been reported to have a greater diagnostic accuracy of ACL ruptures (<ref name="Katz and Fingeroth" />).
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==


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== References  ==
== References  ==


<references />
References will automatically be added here, see [[Adding References|adding references tutorial]].
 
<references /><br>

Revision as of 23:12, 26 September 2014

Original Editor - Kathryn Schwartzkopf-Phifer

Top Contributors - Alistair James, Kathryn Schwartzkopf-Phifer, Laura Ritchie, Deborah Feiner, Admin, Roel De Groef, Kim Jackson, Rachael Lowe, Evan Thomas, Ahmed Essam, Kai A. Sigel, WikiSysop, Claire Knott, Wanda van Niekerk, 127.0.0.1, Wendy Snyders, Nupur Smit Shah and Thomas Janicky  

Purpose
[edit | edit source]

To test the integrity of the anterior cruciate ligament (ACL)([1])

Technique
[edit | edit source]

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.[2]

[3]

Evidence
[edit | edit source]

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.[2]  However, a recent meta-analysis reports the sensitivity and specificity as .18-.92 and .78-.98 respectively.[4]  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.[4]  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.[5]

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. [6]

Tests that are more likely to give an accurate result are the pivot shift or the Lachman [7]

Resources[edit | edit source]

add any relevant resources here

Recent Related Research (from Pubmed)[edit | edit source]

Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10

References[edit | edit source]

References will automatically be added here, see adding references tutorial.

  1. ↑ Katz JW, Fingeroth RJ. The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries. The American Journal of Sports Medicine 1986;14:88-91.fckLRhttp://ajs.sagepub.com/content/14/1/88.short (accessed 18 July 2013).
  2. ↑ 2.0 2.1 Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination: fundamentals for the evidence-based clinician. United States: Evidence in Motion; 2008. Cite error: Invalid <ref> tag; name "Flynn, Cleland and Whitman" defined multiple times with different content
  3. ↑ Anterior drawer test - knee. As seen on youtube: http://www.youtube.com/watch?v=yQdBrr3Mmj0
  4. ↑ 4.0 4.1 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. Cite error: Invalid <ref> tag; name "Scholten et al" defined multiple times with different content
  5. ↑ 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.
  6. ↑ 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
  7. ↑ OSTROWSKI JA, Accuracy of 3 diagnostic tests for anterior cruciate ligament tears, Journal of Athletic Training, 2006, 41(1): 120-122


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