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Anterior Drawer Test
The Anterior Drawer test is used to detect anterior cruciate ligament insufficiency.
To perform this test, have the patient lie in the supine position with their hips flexed to 45˚ and their knees flexed to 90˚. Sit across the dorsum of the foot to stabilize its position while grasping the tibia and resting the thumbs on either side of the patellar tendon. Pull the leg forward and observe and feel for the extent of tibial displacement.
Tibial displacement of about 5 mm is considered normal. Displacement of more than 5 mm, or more than that of the uninvolved side, is a positive test indicating anterior cruciate ligament insufficiency.
It is important to note that, in acute injuries, the Anterior Drawer test is not accurate and therefore less useful because:
• Joint effusion prevents visualization of the displacement,
• Hypertonic hamstrings resist the forward translation,
• The posterior capsule and the medial collateral ligament serve as secondary restraints.
In chronic injuries, however, the anterior drawer test becomes more accurate as there is:
• No inflammation or muscular hypertonicity
• Attenuation of the secondary restraints has occurred.
Before performing the Drawer test, the anterior profile of the patient’s knee should be inspected for evidence of a posterior sag sign. This sign is described in a separate video.
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