Anterior Drawer Test (Knee) – Physical Exam

The Anterior Drawer Test is a commonly used in orthopedic examinations to test for anterior cruciate ligament (ACL) integrity. This is one of the most well known and most used special tests in orthopedics and is also one of the easiest to perform.

Involved Structures

  • Anterior Cruciate Ligament (ACL)

Starting Position

The test is performed with the patient in a relaxed supine position with knees bent to approximately 90 degrees. The examiner sits on the both feet of the subject and places his hands around the upper tibia of one leg. The thumbs of both hands are on the supero-anterior aspect of tibia.

Test Movement

From the starting position the examiner pulls anteriorly on the proximal tibia.

Positive Test

This test is considered positive if there is a soft end feel to the translation of the tibia. A soft end feel / endpoint is indicative of secondary structures stopping the continued anterior translation of the tibia. Excessive anterior translation should also be noted. A hard/firm end feel will be felt when the ACL is intact and abruptly halts continued anterior translation. The positiveness of the test is determined by end feel and also by the amount of translation. The examiner should do the same test movement on the other leg as comparison. This is easy to do from the same starting position, seated on the subjects feet.

Accuracy/Reliability of the Anterior Drawer Test

The Anterior Drawer Test is fairly accurate but has been shown in a number of studies to be less accurate than the Lachman Test and the Pivot Shift Test.

Kai demonstrates the anterior drawer test used in the assessment of anterior cruciate ligament injury
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