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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Anterior Drawer Test



- See:
       - Anterior Cruciate Ligament
       - Pivot shift
       - Clunk Test
       - Losee Test

- Discussion:
    - to perform anterior drawer test, examiner grasps pt's tibia & pulls it forward while noting degree of anterior tibial displacement;
    - anteromedial rotatory instability:
            - positive anterior drawer test in neutral tibial rotation;
                  - anteromedial instability is apparent when w/ stress testing medial plateau of tibia rotates anteriorly & externally as the joint 
                         opens on the medial side;
            - drawer test is accentuated in 30 deg of external rotation;
            - drawer test is reduced w/ tibia in 15 deg of internal rotation;
     - anterolateral rotatory instability
     - internal rotation:
            - in one plane anterior instability, drawer test becomes negative as tibia is internally rotated to 30 deg, due to tightening of PCL;
            - positive anterior drawer sign that is changed very little by internal rotation of tibia suggests PCL is torn;
            - internal rotation tightens structures on posterolateral side of knee;
                  - normally there should be reduced movement when the leg is pulled forward, even if the ACL is torn;
     - external rotation:
            - tightens posteromedial portion of joint capsule;
            - normally there should be reduced forward movement of the tibia on femur, even if ACL is torn;
            - if forward movement w/ leg in external rotation is equal to forward movement w/ leg in neutral position, then there is injury to:
                    - ACL;
                    - posteromedial portion of joint capsule;
                    - possibly MCL;
- Lachman variation:
     - performing examination w/ knee at 15-25 deg of flexion



Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study.

Long-term functional results in patients with anterolateral rotatory instability treated by iliotibial band transfer.

The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral and anteromedial instability. A biomechanical study of cadaver knees.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, April 30, 2012 2:35 pm