Anterior drawer test

By sitting on the patient's foot the limb is maintained with the knee at a right angle while the test is performed.

How to perform the anterior drawer test

With the patient lying on his/her back, the leg is bent and the surgeon places the thumbs on either side of the patellar tendon, with the fingers behind the upper tibia.

Then the examiner firmly pulls the tibia forward, assessing its forward movement and comparing this degree of movement with the normal side. The forwards movement should be less than 6mm.

The test is commonly performed right before surgery, when the patient is under anaesthesia, as the accuracy of the test improves considerably since the patient is no longer guarding the joint.

• Quote from peer-reviewed paper:

  "The diagnosis of the ACL injury and the decision to reconstruct ACL could be reliably made with regards to the anterior drawer...."

  Citation: Makhmalbaf H, Moradi A, Ganji S, Omidi-Kashani F. Accuracy of lachman and anterior drawer tests for anterior cruciate ligament injuries. Arch Bone Jt Surg. 2013 Dec;1(2):94-7. Epub 2013 Dec 15. PMID: 25207297; PMCID: PMC4151408.

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What is the examiner feeling for in the anterior drawer test?

The examiner is evaluating any displacement of the tibia in relation to the femur when the tibia is drawn forwards (anteriorly).

If the cruciate ligament is torn or has come away from its bony attachment, this forwards displacement of the tibia will be greater than normal. Usually the comparison would be with the other limb.

• Quote from peer-reviewed paper:

  These researchers found "....somewhat limited utility of MRI in the diagnosis of ACL injury in the setting of a positive clinical examination....[but] MRI may continue to offer clinical utility in the evaluation of secondary injuries...."

  Citation: Kulwin RL, Schmidt GJ, Snyder DA, Klitzman RG. Clinical Examination in the Diagnosis of Anterior Cruciate Ligament Injury: A Blinded, Cross-sectional Evaluation. J Am Acad Orthop Surg Glob Res Rev. 2023 Feb 8;7(2):e22.00123. doi: 10.5435/JAAOSGlobal-D-22-00123. PMID: 36758231; PMCID: PMC9915950.