The Posterior Drawer Test assesses posterior tibial translation with the knee flexed, most commonly in relation to posterior cruciate ligament function. A positive result may increase suspicion of PCL-related posterior knee laxity, especially when it matches the client’s history and other findings, but it does not confirm a PCL injury on its own.

Introduction

Posterior cruciate ligament injuries are less common than ACL injuries, but they can affect knee stability, confidence and function.

They may occur with:

• dashboard-type trauma
• a fall onto a bent knee
• contact sport trauma
• hyperflexion injury
• multi-ligament knee injury
• recurrent posterior knee instability

The Posterior Drawer Test is one of the most commonly used clinical tests for assessing posterior tibial translation and possible PCL-related laxity.

It is commonly used alongside:

• Posterior Sag Sign
• Quadriceps Active Test
• Dial Test
• knee swelling assessment
• range of motion testing
• gait and functional assessment
• mechanism-of-injury history
• imaging where clinically appropriate

Clinical sources and reviews describe the Posterior Drawer Test as an important physical examination test for suspected PCL injury, but diagnosis is usually made by combining history, physical examination, mechanical testing, imaging and professional judgement rather than one test alone.  

Quick Summary

• Test name: Posterior Drawer Test
• Body region: Knee
• Purpose: Assess posterior tibial translation
• Commonly associated presentation: Posterior cruciate ligament injury or posterior knee laxity
• Positive finding: Increased posterior tibial translation or soft endpoint compared with the other side
• Negative finding: Firm endpoint with no meaningful side-to-side posterior translation difference
• Best used with: Posterior Sag Sign, Quadriceps Active Test, Dial Test, swelling assessment and mechanism-of-injury history
• Key limitation: Grade 1 or partial injuries may be harder to identify; results should be interpreted with other findings

What Is the Posterior Drawer Test?

The Posterior Drawer Test is a knee orthopaedic test used to assess posterior translation of the tibia relative to the femur.

It is most commonly associated with the posterior cruciate ligament, which helps resist posterior movement of the tibia.

The test is performed with the:

• client lying supine
• hip flexed
• knee flexed to approximately 90 degrees
• foot stabilised
• examiner applying a posterior force to the proximal tibia

The examiner observes and feels for:

• posterior tibial translation
• side-to-side difference
• endpoint quality
• pain response
• guarding
• posterior sag before testing

Why It Is Used

The Posterior Drawer Test may help support assessment reasoning when PCL injury or posterior knee laxity is suspected.

It may help professionals:

• assess posterior tibial translation
• compare the symptomatic and non-symptomatic knee
• identify posterior laxity
• grade the amount of posterior movement
• document pain, guarding or instability response
• guide further assessment selection
• support referral or imaging discussion where appropriate

The test should not be used as a stand-alone diagnosis.

What It Assesses

The Posterior Drawer Test assesses posterior tibial translation at the knee.

It may provide information about:

• PCL-related posterior laxity
• posterior knee instability
• endpoint quality
• side-to-side difference
• symptom response during posterior loading
• possible multi-ligament involvement when findings are large or complex

It does not directly identify:

• exact PCL tear grade
• partial versus complete tear with certainty
• associated posterolateral corner injury
• meniscal injury
• cartilage injury
• bone bruising
• readiness to return to sport

Who It Is Useful For

This test may be useful for:

• rehabilitation professionals
• exercise professionals working within scope
• strength and conditioning coaches working with allied health teams
• performance coaches
• movement assessment professionals
• students learning knee special tests
• professionals using Measurz or MAT for structured assessment recording

It may be relevant for clients who report:

• trauma to the front of the shin
• fall onto a bent knee
• posterior knee instability
• difficulty decelerating
• instability on stairs or slopes
• giving-way sensations
• swelling after knee trauma
• previous PCL injury or reconstruction

When to Use This Test

Use the Posterior Drawer Test when the history suggests possible PCL-related posterior knee laxity and the client can tolerate controlled testing.

It may be useful when the client reports:

• dashboard-type injury mechanism
• fall onto the front of the tibia
• hyperflexion injury
• posterior knee pain after trauma
• instability during deceleration
• difficulty with downhill walking
• giving way during sport or daily activity

The test is more meaningful when posterior translation is clearly different from the other knee.

When Not to Use or When to Be Cautious

Use caution with:

• acute painful knee trauma
• large swelling or suspected haemarthrosis
• suspected fracture
• suspected multi-ligament injury
• recent knee surgery
• severe pain
• high irritability
• strong guarding
• limited knee flexion
• suspected neurovascular injury

Stop testing if:

• pain escalates
• the client feels unsafe
• guarding prevents accurate testing
• symptoms worsen significantly
• the client asks to stop
• there are red flags requiring medical review

Equipment Required

• Treatment table or plinth
• Pain scale
• Symptom and confidence recording
• Measurz recording workflow
• Optional comparison-side notes
• Optional referral or further assessment notes where appropriate

Step-by-Step Protocol / Practice

Setup

Position the client lying supine.

Explain the test clearly before starting.

The client should understand that the test assesses controlled posterior movement of the tibia and that testing will stop if symptoms become unsafe or uncomfortable.

Client Position

• Client lies on their back
• Hip is flexed to approximately 45 degrees
• Knee is flexed to approximately 90 degrees
• Foot is flat on the table
• Hamstrings should be relaxed
• Compare both knees where appropriate

Examiner / Professional Position

• Sit lightly on the client’s foot or stabilise it securely
• Face the client’s knee
• Place both hands around the proximal tibia
• Keep thumbs near the tibial tuberosity or joint line for reference
• Observe the resting position of the tibia before applying force

Hand Placement

• Both hands contact the proximal tibia
• Fingers wrap around the back of the upper calf
• Thumbs rest near the anterior tibia or joint line
• Avoid pressing into painful soft tissue unnecessarily

Stabilisation

Stabilise the foot so it does not slide.

Monitor for:

• hamstring contraction
• quadriceps guarding
• hip rotation
• foot movement
• pelvic movement
• pain or apprehension

The hamstrings should stay relaxed because hamstring contraction can reduce posterior translation and affect the result.

Movement or Force Direction

Apply a controlled posterior force to the proximal tibia.

The force should be:

• straight posterior
• firm but not aggressive
• slow enough to feel endpoint quality
• compared with the opposite side

Assess:

• amount of posterior translation
• endpoint firmness
• side-to-side difference
• symptom response
• guarding

Instructions

Ask the client to:

• relax the thigh muscles
• keep the foot relaxed
• report pain or instability
• describe whether the sensation is familiar
• tell you if they want the test stopped

Example instruction:

“I’m going to gently push your shin backwards to assess knee stability. Stay as relaxed as possible and tell me if you feel pain, instability or apprehension.”

Positive Finding

A positive Posterior Drawer Test may include:

• increased posterior tibial translation compared with the other side
• soft or absent endpoint
• posterior sag before testing
• familiar posterior instability
• pain or apprehension with posterior loading
• large side-to-side difference

Posterior translation is often graded by comparing the tibial position to the femoral condyles and the opposite knee.

Negative Finding

A negative finding involves:

• firm endpoint
• no meaningful increase in posterior translation
• no clear side-to-side difference
• no familiar instability response
• no posterior sag at rest

Stopping Criteria

Stop if:

• pain increases sharply
• the client becomes highly apprehensive
• guarding prevents accurate testing
• the knee cannot be positioned safely
• symptoms feel unsafe
• the client asks to stop

Safety Notes

• Do not force the tibia aggressively
• Check for posterior sag before testing
• Compare both sides where possible
• Record whether pain, laxity or instability was the main response
• Use caution in suspected multi-ligament injury

Positive and Negative Test Interpretation

A positive Posterior Drawer Test may increase suspicion of PCL-related posterior knee laxity when posterior tibial translation is greater than the comparison side.

A positive result is more meaningful when it matches:

• dashboard-type trauma
• fall onto a flexed knee
• posterior sag sign
• quadriceps active test findings
• giving-way symptoms
• posterior knee instability
• relevant imaging findings where available

A positive result does not confirm a PCL tear on its own.

Other factors may influence the result, including:

• hamstring guarding
• pain
• swelling
• examiner force
• generalised joint laxity
• previous knee injury
• posterolateral corner involvement
• multi-ligament injury
• incorrect starting position due to posterior sag

A negative test may reduce suspicion when:

• the test is performed well
• the client is relaxed
• there is no posterior sag
• no side-to-side difference is present
• the history is not suggestive of PCL injury

However, a negative result does not fully exclude PCL injury, especially with:

• partial injury
• grade 1 laxity
• acute pain or swelling
• guarding
• poor relaxation
• complex multi-structure injury

Interpretation is stronger when combined with mechanism of injury, swelling, posterior sag, quadriceps active test, dial test and imaging where clinically appropriate.

Sensitivity, Specificity and Diagnostic Accuracy

The Posterior Drawer Test is generally considered one of the stronger clinical tests for PCL injury, particularly for higher-grade posterior laxity.

A commonly cited blinded clinical examination study reported high diagnostic accuracy for detecting PCL tear, with approximately:

• Sensitivity: 90%
• Specificity: 99%
• Accuracy: 96%

The same clinical summaries note that examination accuracy may be higher for grade 2 and grade 3 posterior laxity than for grade 1 laxity.  

A JOSPT systematic review on physical examination tests for PCL injury emphasised that diagnosis is generally made by combining:

• history
• physical examination
• mechanical testing
• imaging
• arthroscopy where relevant

rather than relying on one clinical test alone.  

Practical interpretation:

• Higher sensitivity may make a negative result more useful for decreasing suspicion, but it does not exclude PCL injury on its own.
• Higher specificity may make a positive result more useful for increasing suspicion, but it does not confirm PCL injury on its own.
• Grade 1 or partial injuries may be harder to detect.
• Accuracy depends on examiner skill, client relaxation, injury chronicity and the reference standard used.
• The result should be combined with history, posterior sag, quadriceps active test, dial test and imaging where appropriate.

Reliability and Validity

Reliability improves when the test is performed with consistent:

• hip position
• knee flexion angle
• foot stabilisation
• hand placement
• posterior force direction
• comparison-side testing
• endpoint judgement
• grading method

Reliability may be reduced by:

• hamstring contraction
• pain
• swelling
• guarding
• examiner inexperience
• inconsistent posterior force
• failure to recognise posterior sag
• generalised laxity

Validity is stronger when the result matches:

• relevant injury mechanism
• posterior sag sign
• quadriceps active test
• functional instability
• side-to-side difference
• imaging findings where clinically appropriate

Stress radiography in the posterior drawer position can quantify posterior tibial translation. A 2022 study found that 90-degree posterior drawer stress radiographs had sensitivity of 90.5% and specificity of 94.7% at a 10 mm cut-off for symptomatic PCL insufficiency. This supports the importance of posterior tibial translation measurement, but those values apply to stress radiography rather than the manual clinical test.  

Common Errors and Limitations

Common errors include:

• missing posterior sag before testing
• starting with the tibia already posteriorly displaced
• allowing hamstring contraction
• not stabilising the foot
• applying force too quickly
• applying force in the wrong direction
• not comparing both sides
• interpreting pain alone as positive
• not assessing endpoint quality
• using the test as a stand-alone diagnosis

Limitations include:

• grade 1 laxity may be difficult to detect
• acute pain and swelling can reduce accuracy
• hamstring guarding can mask posterior translation
• examiner experience affects interpretation
• multi-ligament injuries can complicate findings
• side-to-side comparison may be difficult if both knees are abnormal

Practical Applications

The Posterior Drawer Test may help professionals:

• assess posterior knee laxity
• support PCL-related assessment reasoning
• compare involved and uninvolved knees
• document baseline instability response
• monitor change over time
• guide referral or imaging discussion
• support communication with allied health or sports medicine teams

For athletes, it may contribute to broader return-to-training reasoning when combined with:

• strength testing
• deceleration assessment
• landing assessment
• change-of-direction testing
• confidence measures
• sport-specific movement testing

For general population clients, it may help explain symptoms during:

• stairs
• slopes
• kneeling
• deceleration
• getting up from low positions

For Measurz users, the main value is consistent recording of side, posterior translation, endpoint quality, pain, instability response and related findings.

How to Record This in Measurz

Record:

• test name: Posterior Drawer Test
• side tested: left, right or both
• result: positive, negative, unclear or unable to test
• grade if used: grade 0, 1, 2 or 3
• client position
• hip and knee angle
• foot stabilisation method
• force direction: posterior tibial translation
• amount of posterior translation if estimated
• endpoint quality: firm, soft or absent
• posterior sag present or absent
• pain score from 0–10
• symptom location
• symptom quality
• whether symptoms were familiar
• guarding or hamstring contraction
• comparison side
• irritability level
• reason for stopping if stopped early
• related findings, such as posterior sag, quadriceps active test, dial test or swelling
• interpretation notes
• planned retest date if monitoring change

Record whether the main response was:

• increased posterior translation
• soft endpoint
• posterior sag
• familiar instability
• pain only
• guarding
• unclear response
• unable to test safely

This improves:

• repeatability
• communication
• client education
• assessment reasoning
• team consistency
• progress monitoring
• reporting quality

Related Tests / Internal Links

• Posterior Sag Sign
• Quadriceps Active Test
• Dial Test
• Lachman Test
• Anterior Drawer Test
• Pivot Shift Test
• Sweep Test
• Knee Range of Motion Tests

FAQs

What does the Posterior Drawer Test assess?

It assesses posterior tibial translation, most commonly in relation to posterior cruciate ligament function.

What is a positive Posterior Drawer Test?

A positive result may include increased posterior tibial translation, a soft endpoint or clear side-to-side difference compared with the other knee.

Does a positive Posterior Drawer Test confirm a PCL injury?

No. It may increase suspicion of PCL-related posterior laxity, but it does not confirm a PCL injury on its own.

Does a negative test exclude a PCL injury?

No. A negative result does not fully exclude PCL injury, especially with partial injury, low-grade laxity, pain, swelling or guarding.

Why is the posterior sag sign important?

Posterior sag can show that the tibia is already sitting posteriorly. If this is missed, the examiner may underestimate or misinterpret posterior drawer movement.

How accurate is the Posterior Drawer Test?

Commonly cited evidence reports sensitivity around 90%, specificity around 99% and accuracy around 96% for PCL tear detection, but accuracy may be lower for grade 1 laxity and depends on study methods and examiner skill.  

What should the Posterior Drawer Test be used with?

It is best used with history, posterior sag sign, quadriceps active test, dial test, swelling assessment, functional testing and imaging where appropriate.

Key Takeaways

• The Posterior Drawer Test assesses posterior tibial translation.
• It is most commonly used in PCL-related knee assessment.
• A positive result may include increased posterior translation or a soft endpoint.
• A positive test may increase suspicion of PCL-related laxity but does not confirm injury on its own.
• A negative test does not fully exclude PCL injury.
• Grade 1 or partial injuries may be harder to detect.
• Interpretation is stronger when combined with history, posterior sag, quadriceps active test, dial test, functional assessment and imaging where relevant.
• Measurz should record side, result, grade, endpoint quality, posterior sag, pain, guarding, comparison side and related findings.

References

American Academy of Orthopaedic Surgeons. (2022). Management of anterior cruciate ligament injuries: Evidence-based clinical practice guideline. https://www.aaos.org/aclcpg

Jung, T. M., Reinhardt, C., Scheffler, S. U., & Weiler, A. (2022). Stress radiographs in the posterior drawer position at 90° flexion should be part of the diagnostic algorithm for chronic PCL insufficiency. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 835–843. https://pmc.ncbi.nlm.nih.gov/articles/PMC8880224/

Kopf, S., Beaufils, P., Hirschmann, M. T., Rotigliano, N., Ollivier, M., Pereira, H., Verdonk, R., Darabos, N., Ntagiopoulos, P., & Dejour, D. (2020). Management of traumatic posterior cruciate ligament injuries: The 2018 ESSKA PCL consensus. Knee Surgery, Sports Traumatology, Arthroscopy, 28, 1230–1242. https://doi.org/10.1007/s00167-020-05884-x

Schulz, M. S., Russe, K., Weiler, A., Eichhorn, H. J., & Strobel, M. J. (2003). Epidemiology of posterior cruciate ligament injuries. Archives of Orthopaedic and Trauma Surgery, 123, 186–191. https://doi.org/10.1007/s00402-002-0471-y