Posterior Drawer Test (Knee): Difference between revisions
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''' | '''Original Editors '''- [[User:Kathryn Schwartzkopf-Phifer|Kathryn_Schwartzkopf-Phifer]],[[User:Rachael Lowe|Rachael Lowe]] | ||
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== Purpose<br> == | == Purpose<br> == | ||
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== Technique<br> == | == Technique<br> == | ||
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 posteriorly. The test is considered positive if there is a lack of end feel or excessive posterior translation <ref>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> <ref>Magee DJ. Orthopedic Physical Assessment: 5th Edition. St. Louis, MO: Saunders Elsevier; 2008.</ref><br> | 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 posteriorly. The test is considered positive if there is a lack of end feel or excessive posterior translation <ref>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> <ref>Magee DJ. Orthopedic Physical Assessment: 5th Edition. St. Louis, MO: Saunders Elsevier; 2008.</ref><br> | ||
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Sensitivity and specificity have been reported as .90 and .99 respectively, while -LR is .10 and +LR is 90.<ref>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> Malanga et al concluded that the posterior drawer test was both very sensitive and specific, but is also enhanced by the presence of a posterior sag sign.<ref name="Malanga et al">Malanga GA, Andrus S, Nadler SF, McLean J. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Arch Phys Med Rehabil. 2003;84:592-603.</ref> Budoff and Nirschl agree that the posterior drawer is the best test to determine PCL integrity, but conclude that grading is the most important as this will determine the course of treatment.<ref name="Budoff">Budoff JE, Nirschl RP. Knee problems: diagnostic tests for ligament injuries. Consultant. 1997;919-930.</ref> | Sensitivity and specificity have been reported as .90 and .99 respectively, while -LR is .10 and +LR is 90.<ref>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> Malanga et al concluded that the posterior drawer test was both very sensitive and specific, but is also enhanced by the presence of a posterior sag sign.<ref name="Malanga et al">Malanga GA, Andrus S, Nadler SF, McLean J. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Arch Phys Med Rehabil. 2003;84:592-603.</ref> Budoff and Nirschl agree that the posterior drawer is the best test to determine PCL integrity, but conclude that grading is the most important as this will determine the course of treatment.<ref name="Budoff">Budoff JE, Nirschl RP. Knee problems: diagnostic tests for ligament injuries. Consultant. 1997;919-930.</ref> | ||
Results from a blinded, randomized, controlled study shows that the accuracy for detection of a PCL-tear is 96%, with 90% sensitivity and a 99% specificity. For grade 2 and grade 3 posterior laxity, the examination accuracy was higher than for grade 1 posterior laxity. <ref>The Accuracy of the Clinical Examination in the Setting of Posterior Cruciate Ligament Injuries. Rubinstein RA Jr., Shelbourne KD, McCarroll JR, et al: Am J Sports Med 22: 550-557, 1994 (level of evidence: A2)</ref><br> | Results from a blinded, randomized, controlled study shows that the accuracy for detection of a PCL-tear is 96%, with 90% sensitivity and a 99% specificity. For grade 2 and grade 3 posterior laxity, the examination accuracy was higher than for grade 1 posterior laxity. <ref>The Accuracy of the Clinical Examination in the Setting of Posterior Cruciate Ligament Injuries. Rubinstein RA Jr., Shelbourne KD, McCarroll JR, et al: Am J Sports Med 22: 550-557, 1994 (level of evidence: A2)</ref><br> | ||
== Resources == | == Resources == | ||
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<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1dk9JPLbeoT4FK_3EKBD27O6CBxf_ajAiUS0XprDF7JJKeYETw|charset=UTF-8|short|max=10</rss> | <rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1dk9JPLbeoT4FK_3EKBD27O6CBxf_ajAiUS0XprDF7JJKeYETw|charset=UTF-8|short|max=10</rss> | ||
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== References == | == References == | ||
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<references /><br> | <references /><br> | ||
[[Category:Videos]] [[Category:Assessment]] [[Category:EIM_Residency_Project]] [[Category:Knee]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Special_Tests]] | |||
Revision as of 03:54, 30 September 2014
Original Editors - Kathryn_Schwartzkopf-Phifer,Rachael Lowe
Top Contributors - Admin, Laura Ritchie, Kathryn Schwartzkopf-Phifer, Roel De Groef, Rachael Lowe, Kim Jackson, Jennifer Chew, Tony Lowe, Oyemi Sillo, Kai A. Sigel, Dan Rhon, Evan Thomas, WikiSysop, Claire Knott and Wanda van Niekerk
Purpose
[edit | edit source]
To test the integrity of the posterior cruciate ligament (PCL)
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 posteriorly. The test is considered positive if there is a lack of end feel or excessive posterior translation [1] [2]
| [3] | [4] |
Evidence
[edit | edit source]
Sensitivity and specificity have been reported as .90 and .99 respectively, while -LR is .10 and +LR is 90.[5] Malanga et al concluded that the posterior drawer test was both very sensitive and specific, but is also enhanced by the presence of a posterior sag sign.[6] Budoff and Nirschl agree that the posterior drawer is the best test to determine PCL integrity, but conclude that grading is the most important as this will determine the course of treatment.[7]
Results from a blinded, randomized, controlled study shows that the accuracy for detection of a PCL-tear is 96%, with 90% sensitivity and a 99% specificity. For grade 2 and grade 3 posterior laxity, the examination accuracy was higher than for grade 1 posterior laxity. [8]
Resources[edit | edit source]
http://www.aclmd.com/Publications/Abstracts%20pdf/PCL_Accuracy.pdf
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination: fundamentals for the evidence-based clinician. United States; Evidence in motion: 2008.
- ↑ Magee DJ. Orthopedic Physical Assessment: 5th Edition. St. Louis, MO: Saunders Elsevier; 2008.
- ↑ Clinically Relevant Technologies. Posterior Drawer Test Knee. Available from: http://www.youtube.com/watch?v=mRyEvBrrl1k [last accessed 29/09/14]
- ↑ Med School Easy. Posterior Drawer Test. Available from: http://www.youtube.com/watch?v=3vKlDaxcC8Q [last accessed 29/09/14]
- ↑ Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination: fundamentals for the evidence-based clinician. United States; Evidence in Motion: 2008.
- ↑ Malanga GA, Andrus S, Nadler SF, McLean J. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Arch Phys Med Rehabil. 2003;84:592-603.
- ↑ Budoff JE, Nirschl RP. Knee problems: diagnostic tests for ligament injuries. Consultant. 1997;919-930.
- ↑ The Accuracy of the Clinical Examination in the Setting of Posterior Cruciate Ligament Injuries. Rubinstein RA Jr., Shelbourne KD, McCarroll JR, et al: Am J Sports Med 22: 550-557, 1994 (level of evidence: A2)
