Posterior Drawer Test (Knee): Difference between revisions
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== Purpose<br>  ==
== Purpose<br>  ==


To test the integrity of the posterior cruciate ligament (PCL)
The posterior drawer test evaluates the posterior cruciate ligament. <br>


== 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><br> {{#ev:youtube|mRyEvBrrl1k}}<ref>Clinically Relevant Technologies, http://www.youtube.com/watch?v=mRyEvBrrl1k, Accessed May 2011</ref>
The patient laying supine with the knee in ninety degrees of flexion. The foot of the patient is stabilized on the table. The fysiotherapist grabs the anterior aspect of the tibia over the tibial tuberosity and push forward with a steady force. The tibia displaces posteriorly. If the posterior translation of the tibia is more than normal (compared with the healthy side), the test is positive. This is indicative of a posterior cruciate ligament tear. (1)


== Evidence<br> ==
== Evidence  ==


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>&nbsp; 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>&nbsp; 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. (2)


== Resources  ==
== Resources  ==


add any relevant resources here
- http://www.aclmd.com/Publications/Abstracts%20pdf/PCL_Accuracy.pdf
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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== References  ==
 
References will automatically be added here, see [[Adding References|adding references tutorial]].  


<references /><br>  
== References<br> ==


[[Category:Articles]] [[Category:Assessment]] [[Category:EIM_Residency_Project]] [[Category:Knee]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Special_Tests]]
(1) Magee DJ. Orthopedic Physical Assessment: 5th Edition. St. Louis, MO: Saunders Elsevier;2008.<br>(2) 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)<br>

Revision as of 23:07, 28 June 2011

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Purpose
[edit | edit source]

The posterior drawer test evaluates the posterior cruciate ligament.

Technique
[edit | edit source]

The patient laying supine with the knee in ninety degrees of flexion. The foot of the patient is stabilized on the table. The fysiotherapist grabs the anterior aspect of the tibia over the tibial tuberosity and push forward with a steady force. The tibia displaces posteriorly. If the posterior translation of the tibia is more than normal (compared with the healthy side), the test is positive. This is indicative of a posterior cruciate ligament tear. (1)

Evidence[edit | edit source]

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. (2)

Resources[edit | edit source]

- http://www.aclmd.com/Publications/Abstracts%20pdf/PCL_Accuracy.pdf

References
[edit | edit source]

(1) Magee DJ. Orthopedic Physical Assessment: 5th Edition. St. Louis, MO: Saunders Elsevier;2008.
(2) 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)

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