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