Knee Orthopaedic Test: Anterior Drawer Test of the Knee

The Anterior Drawer Test of the Knee is a physical examination maneuver used to assess the integrity of the anterior cruciate ligament (ACL) of the knee joint. This test involves the examiner pulling the tibia anteriorly (forward) relative to the femur.

Here are the steps to perform the Anterior Drawer Test of the Knee:

1. The patient lies supine on a flat surface, with the knee flexed at approximately 90 degrees.
2. The examiner stands on the affected side of the patient.
3. The examiner places both hands around the proximal tibia, just below the joint line, with the thumbs on the tibial plateau and the fingers wrapping around the posterior aspect of the lower leg.
4. The examiner pulls the tibia anteriorly (forward), attempting to translate the tibia forward relative to the femur.
5. The examiner notes the amount of anterior displacement, as well as any abnormal laxity or lack of resistance felt during the maneuver.
6. The test is then repeated on the unaffected knee for comparison.
7. The examiner may also perform a Lachman Test, which is a similar maneuver but with the knee flexed at approximately 30 degrees, to further assess ACL integrity.

References:

1. Magee, D. J. (2013). Orthopedic physical assessment (6th ed.). St. Louis, MO: Saunders/Elsevier.
2. Dutton, M. (2012). Dutton's orthopedic examination, evaluation, and intervention (3rd ed.). New York, NY: McGraw-Hill Medical.
3. Evans, J. D. (2015). Illustrated orthopedic physical assessment (3rd ed.). St. Louis, MO: Elsevier.
4. McKeon, B., et al. (2013). The accuracy of the Lachman and anterior drawer tests in predicting ACL graft failure within the first 2 years of reconstruction. American Journal of Sports Medicine, 41(9), 2071-2079.
5. Prodromos, C. C., et al. (2007). A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy, 23(12), 1320-1325.e6.
6. van Eck, C. F., et al. (2013). The sensitivity and specificity of the anterior drawer test in predicting ACL graft integrity: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 21(4), 803-810.
7. Hewett, T. E., et al. (2018). Understanding and preventing ACL injuries: Current biomechanical and epidemiologic considerations - update 2018. North American Journal of Sports Physical Therapy, 13(4), 234-251.
8. Hertel, J. (2012). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of Athletic Training, 47(4), 364-375.