Anterior Drawer Test of the Knee

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Original Editor - Roel De Groef Lead Editors -Alistair James

Purpose

The ‘anterior drawer’s test’ is a test that provokes a possible ACL-tear. If the ‘anterior drawer’s test’ is positive, an additional test such as the ‘pivot-shift’ test or the ‘Lachman’ test can be performed. These tests have a higher predictive value. (1)

Technique

The patient lies on his back with 45° of hip flexion, 90° flexion of the knee and the tibia in neutral position. The fysiotherapist stabilizes the foot of the patient with his thigh and put both hands on the dorsal side of the proximal part of the tibia. The thumbs of the fysiotherapist are placed on the anterior part of the tibia plateau. The researcher performs an anterior-directed movement and assesses the degree of translation of the tibia. Grading is based on differences of degrees in translation of the affected side compared with the healthy side. (2)

Evidence

Reliable data are rare regarding the accuracy of physical diagnostic tests for ACL ruptures, especially in a primary care setting. To evaluate a possible rupture of the ACL, there are 3 primarily diagnostic assessments: The anterior drawner test, the Lachman test, and the pivot shift test. Based on some study results, the pivot shift test seems to have a favorable positive predictive value, the Lachman test has good negative predictive value, but the anterior drawner test is of unproven value. (3)

Resources

http://www.jfponline.com/pdf%2F5209%2F5209JFP_AppliedEvidence.pdf
http://www.springerlink.com/content/978-90-313-5205-0/#section=35574

PubMed Feed


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References

(1) Onderzoek en behandeling van de knie; Koos van Nugteren en Dos Winkel; Bohn Stafleu van Loghum; Houten, 2008
(2) Klinische diagnostiek van een voorste-kruisbandruptuur; Een meta-analyse; Stimulus 26e jaargang nummer 2 (pg 174-200); 2007 (level of evidence: A1)
(3) Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: A meta- analysis; Rob J.P.M. Scholten, Wim Opstelten, Cees G. van der plas, Dick Bijl, Walter L.J.M. Devillé and Lex M. Bouter; The journal of Family Practice: Sep. 2003/ Vol. 52, NO9 (Level of evidence: A2)

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