Anterior Drawer Test of the Knee: Difference between revisions

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'''Original Editor '''- Kathryn Schwartzkopf-Phifer<br>


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== Purpose<br>  ==
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Original Editor - Roel De Groef


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>  
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{{#ev:youtube|yQdBrr3Mmj0}} <ref>Anterior drawer test - knee. As seen on youtube: http://www.youtube.com/watch?v=yQdBrr3Mmj0</ref>
== Purpose<br> ==


== Evidence<br>  ==
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>
 
== 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 on his back with 45° of hip flexion, 90° flexion of the knee and the tibia in neutral position. The fysiotherapist stabilizes the foot of the patient with his thigh and put both hands on the dorsal side of the proximal part of the tibia. The thumbs of the fysiotherapist are placed on the anterior part of the tibia plateau. The researcher performs an anterior-directed movement and assesses the degree of translation of the tibia. Grading is based on differences of degrees in translation of the affected side compared with the healthy side. (2)  


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>
Reliable data are rare regarding the accuracy of physical diagnostic tests for ACL ruptures, especially in a primary care setting. To evaluate a possible rupture of the ACL, there are 3 primarily diagnostic assessments: The anterior drawner test, the Lachman test, and the pivot shift test. Based on some study results, the pivot shift test seems to have a favorable positive predictive value, the Lachman test has good negative predictive value, but the anterior drawner test is of unproven value. (3)  


== Resources  ==
== Resources  ==


add any relevant resources here
http://www.jfponline.com/pdf%2F5209%2F5209JFP_AppliedEvidence.pdf<br>http://www.springerlink.com/content/978-90-313-5205-0/#section=35574<br>
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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 ==


References will automatically be added here, see [[Adding References|adding references tutorial]].  
(1) Onderzoek en behandeling van de knie; Koos van Nugteren en Dos Winkel; Bohn Stafleu van Loghum; Houten, 2008<br>(2) Klinische diagnostiek van een voorste-kruisbandruptuur; Een meta-analyse; Stimulus 26e jaargang nummer 2 (pg 174-200); 2007 (level of evidence: A1)<br>(3) Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: A meta- analysis; Rob J.P.M. Scholten, Wim Opstelten, Cees G. van der plas, Dick Bijl, Walter L.J.M. Devillé and Lex M. Bouter; The journal of Family Practice: Sep. 2003/ Vol. 52, NO9 (Level of evidence: A2)<br>


<references /><br>
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Revision as of 13:51, 18 August 2013

Be the first to edit this page and have your name permanently included as the originating editor, see the editing pages tutorial for help.

Original Editor - Roel De Groef

Lead Editors - If you would like to be a lead editor on this page, please contact us.


Purpose
[edit | edit source]

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]

The patient lies on his back with 45° of hip flexion, 90° flexion of the knee and the tibia in neutral position. The fysiotherapist stabilizes the foot of the patient with his thigh and put both hands on the dorsal side of the proximal part of the tibia. The thumbs of the fysiotherapist are placed on the anterior part of the tibia plateau. The researcher performs an anterior-directed movement and assesses the degree of translation of the tibia. Grading is based on differences of degrees in translation of the affected side compared with the healthy side. (2)

Evidence[edit | edit source]

Reliable data are rare regarding the accuracy of physical diagnostic tests for ACL ruptures, especially in a primary care setting. To evaluate a possible rupture of the ACL, there are 3 primarily diagnostic assessments: The anterior drawner test, the Lachman test, and the pivot shift test. Based on some study results, the pivot shift test seems to have a favorable positive predictive value, the Lachman test has good negative predictive value, but the anterior drawner test is of unproven value. (3)

Resources[edit | edit source]

http://www.jfponline.com/pdf%2F5209%2F5209JFP_AppliedEvidence.pdf
http://www.springerlink.com/content/978-90-313-5205-0/#section=35574

References
[edit | edit source]

(1) Onderzoek en behandeling van de knie; Koos van Nugteren en Dos Winkel; Bohn Stafleu van Loghum; Houten, 2008
(2) Klinische diagnostiek van een voorste-kruisbandruptuur; Een meta-analyse; Stimulus 26e jaargang nummer 2 (pg 174-200); 2007 (level of evidence: A1)
(3) Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: A meta- analysis; Rob J.P.M. Scholten, Wim Opstelten, Cees G. van der plas, Dick Bijl, Walter L.J.M. Devillé and Lex M. Bouter; The journal of Family Practice: Sep. 2003/ Vol. 52, NO9 (Level of evidence: A2)

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