Video – Hughston’s Posteromedial and Posterolateral Drawer Tests

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Hughston’s Posteromedial and Posterolateral Drawer Tests

Procedure and Significance
The tests are performed in two parts. For both, the patient lies supine with the hips flexed to 45˚, the knees flexed to 90˚ and with the feet lying flat on the table.

Part 1- Posteromedial Instability:
To test for posteromedial rotary instability, ask the patient to turn their foot of the involved side inwards. Sit on the dorsum of the foot to stabilize its position, grasp the upper tibia, and place the thumbs on either side of the patellar tendon. Now push the tibia posteriorly and observe and feel for the extent of its backward displacement.

The test is positive if the backward movement of the tibia occurs primarily on the medial side of the involved knee and this movement is excessive when compared to the uninvolved knee.

When positive, the test indicates possible injury to a number of structures including the following:

  • Posterior cruciate ligament
  • Posterior oblique ligament
  • Medial collateral ligament
  • Posteromedial capsule

Part 2- Posterolateral Instability:
To test for posterolateral rotary instability,
the procedure is repeated with the foot turned outward.

The test is positive if the backward movement of the tibia occurs primarily on the lateral side of the involved knee and this movement is excessive relative to the uninvolved knee.

When positive, the test indicates possible injury to a number of structures including the following:

  • Posterior cruciate ligament
  • Lateral collateral ligament
  • Posterolateral capsule

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