Sports Med - Special Tests: Knee

Anterior Drawer test - Examiner’s position

Patient:

• Lying supine

• Hip flexed to 45°

• Knee flexed to 90°

Examiner:

• Sitting on exam table in front of patient

• Thumbs along joint line

• Other fingers palpating hamstring tendons

Anterior Drawer test - Action

Tibia is drawn anteriorly

Anterior Drawer test - Positive

• Increased laxity

• Lack of firm endpoint

Anterior Drawer test - Pathology

ACL sprain

Anterior Drawer test - Differential diagnosis

• MCL sprain

• PCL sprain

Posterior Drawer test - Examiner’s position

Patient:

• Lying supine

• Hip flexed to 45°

• Knee flexed to 90°

Examiner:

• Sitting on exam table in front of patient

• Heels of both palms on anterior tibia

• Thumbs on joint line

Posterior Drawer test - Action

Proximal tibia is pushed posteriorly

Posterior Drawer test - Positive

• Increased laxity

• Lack of firm endpoint

Posterior Drawer test - Pathology

PCL sprain

Posterior Drawer test - Differential diagnosis

• ACL sprain

• MCL sprain

Lachman’s test - Examiner’s position

Patient:

• Lying supine

• Knee passively flexed to 20-25°

Examiner:

• Lateral to patient

• One hand stabilizes the leg right above the knee

• Other hand grasps femur OR is balled into a fist

Lachman’s test - Action

• One hand stabilizes the leg right above the knee

• Other hand draws the tibia anteriorly

Lachman’s test - Positive

• Increased laxity

• Lack of firm endpoint

Lachman’s test - Pathology

ACL sprain

Lachman’s test - Differential diagnosis

• MCL sprain

• PCL sprain

Thessaly’s test - Examiner’s position

Patient:

• Standing on injured leg

• Uninjured leg flexed to 45°

Examiner:

• Standing in front of patient

• Supporting patient’s arms (holding hands or arms)

Thessaly’s test - Action

• Patient flexes injured knee 5° and rotates their body internally and externally

• Patient flexes injured knee 20° and rotates their body internally and externally

• Patient repeats these movements three times

Thessaly’s test - Positive

• Pain

• Joint line discomfort

• Noise sensations (popping, clicking)

• Locking of the knee

Thessaly’s test - Pathology

Meniscal tear

Thessaly’s test - Differential diagnosis

• MCL sprain

• LCL sprain

Apley’s test - Examiner’s position

Patient:

• Lying prone (on stomach)

• Knee flexed to 90°

Examiner:

• One hand stabilizes distal thigh

• Other hand on patient’s heel of foot

Apley’s test - Action

• Compression: Hand on heel compresses downward, internally and externally rotating the tibia

• Distraction: Pull tibia upward, internally and externally rotating the tibia

Apley’s test - Positive

• Pain during compression

• Pain reduced during distraction

Apley’s test - Pathology

Meniscal tear

Apley’s test - Differential diagnosis

• MCL sprain

• LCL sprain