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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To test the integrity of the anterior cruciate ligament (ACL)


<br>  
== Technique<br> ==


== Purpose<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 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>  


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


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


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)
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>


== Evidence  ==
&nbsp;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>


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)
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>


== Resources  ==
== Resources  ==


http://www.jfponline.com/pdf%2F5209%2F5209JFP_AppliedEvidence.pdf<br>http://www.springerlink.com/content/978-90-313-5205-0/#section=35574<br>
add any relevant resources here
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==


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


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


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Revision as of 19:49, 27 June 2011

Original Editor - Kathryn Schwartzkopf-Phifer

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Purpose
[edit | edit source]

To test the integrity of the anterior cruciate ligament (ACL)

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.[1]

[2]

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.[1]  However, a recent meta-analysis reports the sensitivity and specificity as .18-.92 and .78-.98 respectively.[3]  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.[3]  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.[4]

 Thus the functional stability can be maintained. [5]

Tests that are more likely to give an accurate result are the pivot shift or the Lachman [6]

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. ↑ 1.0 1.1 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
  2. ↑ Anterior drawer test - knee. As seen on youtube: http://www.youtube.com/watch?v=yQdBrr3Mmj0
  3. ↑ 3.0 3.1 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
  4. ↑ 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.
  5. ↑ 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
  6. ↑ 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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