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Anterior Drawer Test of the Knee : Clinical essentials

Purpose
To test the integrity of the anterior cruciate ligament (ACL)

Technique
The patient lies supine on a plinth with their hips flexed to 45 degrees, his/her knees flexed to 90 degrees and feet flat on the plinth. The examiner sits on the toes of the tested extremity to help stabilize it. The examiner grasps the proximal lower leg, just below the tibial plateau or tibiofemoral joint line, and attempts to translate the lower leg anteriorly. The test is considered positive if there is a lack of end feel or excessive anterior translation relative to the contralateral side.

Clinical Note
This examination must be performed with particular care because the start position could result in a false-positive anterior drawer test result for the anterior cruciate ligament if a posterior sag (an indication of a posterior cruciate problem) goes unnoticed before the test is started. If minimal or no swelling is present, the sag is evident because of an obvious concavity distal to the patella.

When the anterior drawer test is done, if an audible snap or palpable jerk (Finochietto jumping sign) occurs when the tibia is pulled forward, and the tibia moves forward excessively, a meniscal lesion is likely in addition to the torn anterior cruciate ligament.

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