POSTERIOR

DRAWER TEST
FUNCTION:

To test the integrity of the posterior cruciate ligament (PCL).

The posterior drawer test is part of a normal knee exam. When your
healthcare provider examines the knee, they inspect the joint, test
ligaments and mobility, determine if there is swelling, and perform
specific manipulations to detect abnormalities.

A PCL tear typically occurs as a result of a fall directly on a flexed knee. This
injury can also occur from a hard impact on the knee or tibia from
bending the knee backward, or a knee dislocation.
PROCEDURE :

The patient should be lying supine on the

exam table

Apply an anterior-to-posterior directed

force through the proximal tibia
Have the patient flex the hip and knees to
90°, feet should be flat on the table
(the examiner may sit on the patient’s
foot to ensure it stays flat). Note:
Palpate the hamstring to confirm Note the degree of backward movement in
complete relaxation the femur

On the involved side, place your hands

along the sides of the knee, palpate the
joint line
Repeat the test on the non-involved side
and compare results
POSITIVE TEST:

absence of an end-feel and the proximal tibia

falls back (excessive translation). The
amount of posterior movement determines
the grade of PCL tear.
GRADE OF INJURY:

the posterior drawer is the best test to determine PCL integrity but conclude
that grading is the most important as this will determine the course of
treatment.

Results from a blinded, randomized, controlled study shows that the accuracy
for detection of a PCL-tear is 96%, with 90% sensitivity and a 99%
specificity. For grade 2 and grade 3 posterior laxity, the examination
accuracy was higher than for grade 1 posterior laxity.
INSTRUCTIONAL VIDEO:
 REVERSE
LACHMAN TEST
FUNCTION:

The Lachman test is a passive accessory movement test of the knee

performed to identify the integrity of the anterior cruciate ligament
(ACL). The test is designed to assess single and sagittal plane instability.
PROCEDURE : Lie the patient supine on the bed. Place the patient's knee in about 20-30 degrees flexion. According to
Bates' Guide to Physical Examination, the leg should also be externally rotated slightly. The
examiner should place one hand behind the tibia and the other on the patient's thigh. It is important
that the examiner's thumb be on the tibial tuberosity. On pulling the tibia anteriorly, an intact ACL
should prevent forward translational movement of the tibia on the femur ("firm end-feel").

Anterior translation of the tibia associated with a soft or a mushy end-feel indicates a positive test. More
than about 2mm of anterior translation compared to the uninvolved knee suggests a torn ACL ("soft
end-feel"), as does 10mm of total anterior translation. An instrument called a "KT-1000" can be used
to determine the magnitude of movement in millimeters.
POSITIVE TEST:

A positive Lachman test or pivot test is strong

evidence of an existing anterior cruciate
ligament (ACL) tear, and a negative
Lachman test is fairly good evidence against
that injury.
GRADE OF INJURY:

Most examiners grade the results of the Lachman test on two criteria. First,
the endpoint, and second, the amount of laxity. When assessing the
endpoint, the examiner is feeling for the ACL limiting the amount of
shifting of the shin bone.

Normal: No side-to-side difference.

Grade 1 (mild): 3-5 mm more translation of the tibia on the femur.
Grade 2 (moderate): 5-10 mm more translation of the tibia on the femur.
Grade 3 (severe): >10 mm more translation of the tibia on the femur.
INSTRUCTIONAL VIDEO:
GODFREY TEST
FUNCTION:

A test to identify a tear of the posterior cruciate

ligament.
PROCEDURE :

A test to identify a tear of the posterior cruciate ligament. With the patient
lying supine and the hips and knees flexed to 90°, the examiner lifts
both patient's lower legs and holds them parallel to the table.
The relative position of the lower legs is then observed.
Inferior displacement (a downward sagging) of the involved knee can
indicate a tear of the posterior cruciate ligament.
INSTRUCTIONAL VIDEO: