The Anterior Drawer Test assesses anterior tibial movement relative to the femur to help evaluate ACL-related knee instability. A positive result may increase suspicion of ACL involvement but does not confirm ACL injury on its own.

Introduction

Knee instability after twisting, pivoting or landing injuries is commonly associated with ACL-related presentations.

The Anterior Drawer Test evaluates anterior tibial translation while the knee is flexed to approximately 90 degrees.

It is commonly used alongside:

• Lachman Test
• Pivot Shift Test
• swelling assessment
• mechanism of injury evaluation

A positive result may suggest increased anterior knee laxity, but interpretation should always include symptom history, swelling, functional capacity and other assessment findings.

Quick Summary

Test name: Anterior Drawer Test
Body region: Knee
Purpose: Assess anterior tibial translation and ACL involvement
Positive finding: Increased forward tibial movement or soft end feel
Negative finding: Minimal translation with firm end feel
Best used with: Lachman Test and Pivot Shift Test
Key limitation: Hamstring guarding may affect results

What Is the Anterior Drawer Test?

The Anterior Drawer Test assesses the amount of forward movement of the tibia relative to the femur.

The test aims to evaluate:

• anterior knee stability
• ACL-related laxity
• symptom response during anterior tibial translation

Why It Is Used

The test may help:

• assess suspected ACL injury
• evaluate knee instability
• identify excessive anterior tibial movement
• support return-to-sport assessment reasoning

It is commonly used after:

• pivoting injuries
• sudden direction changes
• awkward landings
• sporting knee trauma

What It Assesses

The Anterior Drawer Test assesses:

• anterior tibial translation
• ACL-related stability
• end-feel quality
• symptom reproduction during knee stress

It does not confirm ACL rupture severity or associated structural damage.

Who It Is Useful For

This test may be useful for:

• sports rehabilitation practitioners
• exercise professionals
• strength and conditioning coaches
• movement assessment professionals
• return-to-sport assessment settings

When to Use This Test

Use when there is:

• knee instability
• giving-way sensation
• swelling after twisting injury
• suspected ACL involvement
• reduced confidence during pivoting movements

When Not to Use or When to Be Cautious

Use caution with:

• acute swelling
• severe pain
• suspected fracture
• recent surgery
• inability to tolerate knee flexion

Stop testing if:

• pain becomes severe
• guarding prevents assessment
• symptoms escalate rapidly

Equipment Required

Treatment table
Pain scale
Measurz recording workflow

Step-by-Step Protocol / Practice

Setup

Position the client lying supine on a treatment table.

Client Position

• Hip flexed approximately 45 degrees
• Knee flexed approximately 90 degrees
• Foot flat on the table

Examiner/Professional Position

Sit gently on the client’s foot to stabilise it.

Hand Placement

Place both hands around the proximal tibia with thumbs near the tibial plateau.

Stabilisation

Ensure the foot remains stable and the hamstrings are relaxed.

Movement or Force Direction

Apply an anterior pulling force through the tibia.

Observe:

• amount of movement
• end feel
• symptom response
• side-to-side differences

Instructions

Ask the client to:

• remain relaxed
• avoid resisting movement
• report discomfort or instability sensations

Positive Finding

A positive Anterior Drawer Test may include:

• increased anterior tibial translation
• soft or absent end feel
• instability sensation
• asymmetry compared to the opposite side

Negative Finding

A negative finding involves:

• firm end feel
• limited tibial translation
• no instability sensation

Stopping Criteria

Stop if:

• pain becomes severe
• guarding prevents accurate assessment
• symptoms significantly worsen

Safety Notes

Hamstring guarding may reduce tibial movement and create false-negative findings.

Compare both knees where appropriate.

Positive and Negative Test Interpretation

A positive Anterior Drawer Test may suggest:

• ACL involvement
• increased anterior knee laxity
• reduced passive knee stability

It becomes more meaningful when combined with:

• Lachman Test findings
• swelling history
• mechanism of injury
• instability symptoms

A negative test may reduce suspicion of major ACL laxity, but it does not fully exclude partial injury or less irritable presentations.

The test does not confirm ACL rupture on its own.

Sensitivity, Specificity and Diagnostic Accuracy

Research shows variable diagnostic accuracy depending on timing after injury, swelling and examiner experience.

Condition or presentation: suspected ACL injury
Population: individuals with knee instability or trauma
Test variation: standard Anterior Drawer Test
Reference standard: MRI, arthroscopy or surgical findings
Sensitivity: generally moderate
Specificity: generally moderate to high
Positive likelihood ratio: variable across studies
Negative likelihood ratio: variable across studies
Key limitations: hamstring guarding, swelling and acute pain may reduce accuracy

Lachman Test is generally considered more sensitive for acute ACL assessment, while the Anterior Drawer Test may provide additional information regarding tibial translation and laxity.

Reliability and Validity

Reliability improves with:

• proper relaxation
• consistent knee positioning
• side-to-side comparison
• experienced examiner technique

Validity is stronger when combined with:

• injury history
• swelling patterns
• functional instability reports
• other ACL tests

Common Errors and Limitations

Common errors include:

• failing to relax hamstrings
• poor tibial hand placement
• inadequate stabilisation
• excessive force application
• not comparing sides

Limitations include:

• reduced sensitivity in acute injuries
• hamstring guarding interference
• limited standalone diagnostic value

Practical Applications

The Anterior Drawer Test may help:

• assess ACL-related laxity
• guide rehabilitation planning
• monitor knee stability over time
• support return-to-sport discussions
• contribute to ACL assessment clusters

How to Record This in Measurz

Record:

• test name
• side tested
• result (positive / negative / unclear)
• amount of anterior translation
• end-feel quality
• pain score (0–10)
• instability sensation
• swelling presence
• comparison side
• guarding level
• related findings
• interpretation notes

Related Tests / Internal Links

Lachman Test
Pivot Shift Test
Lever Sign Test
Posterior Drawer Test
Slocum Test
Sweep Test

FAQs

What does the Anterior Drawer Test assess?

It assesses anterior tibial movement and possible ACL-related instability.

What is a positive Anterior Drawer Test?

Increased forward tibial movement or a soft end feel.

Does it diagnose an ACL tear?

No. It may suggest ACL involvement but does not confirm injury.

Why can the test be negative even with injury?

Hamstring guarding and swelling can reduce tibial movement.

Should it be used alone?

No. It works best with other ACL tests and injury history.

Key Takeaways

What does the Anterior Drawer Test assess?

Anterior knee stability and tibial translation.

Does it confirm an ACL tear?

No. It only helps support assessment reasoning.

What does a positive result mean?

It may suggest increased ACL-related knee laxity.

What does a negative result mean?

It may reduce suspicion of major ACL instability.

Should it be used alone?

No. It works best as part of an ACL assessment cluster.

What is the main value of the test?

Helping identify abnormal anterior tibial movement after knee injury.

References

Hegedus, E. J., et al. (2018–2022). Diagnostic accuracy of knee special tests. British Journal of Sports Medicine.

Benjaminse, A., et al. (2020–2023). Clinical assessment of ACL injury and knee instability. Journal of Orthopaedic & Sports Physical Therapy.

Logerstedt, D. S., et al. (2021). Knee stability and ACL injury clinical practice guideline updates. Journal of Orthopaedic & Sports Physical Therapy.