Anterior Drawer Test of the Knee
Original Editor - Kathryn Schwartzkopf-Phifer
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Purpose
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To test the integrity of the anterior cruciate ligament (ACL)
Technique
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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.[1]
Evidence
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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]
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. [5]
Tests that are more likely to give an accurate result are the pivot shift or the Lachman [6]
Resources[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 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 - ↑ Anterior drawer test - knee. As seen on youtube: http://www.youtube.com/watch?v=yQdBrr3Mmj0
- ↑ 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 - ↑ 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.
- ↑ 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
- ↑ OSTROWSKI JA, Accuracy of 3 diagnostic tests for anterior cruciate ligament tears, Journal of Athletic Training, 2006, 41(1): 120-122
