Orthopedic Exam Maneuvers

The Posterior Drawer Test is a physical examination maneuver used to assess the integrity of the Posterior Cruciate Ligament (PCL) in the knee.

Anatomical Area Assessed:

• Knee joint, specifically testing the Posterior Cruciate Ligament (PCL)

• The PCL prevents posterior translation (backward movement) of the tibia relative to the

Purpose:

• To diagnose a PCL tear or insufficiency

How to Perform the Posterior Drawer Test:

1. Position the Patient:

   • Patient lies supine (on their back)

   • Knee is flexed to 90 degrees

   • Hip is flexed to 45 degrees

   • Foot is flat on the table (stabilized)

2. Examiner’s Hand Position:

   • Sit on the patient’s foot to stabilize it

   • Place both hands around the proximal tibia, with thumbs on the tibial tuberosity

3. Action:

   • Gently push the tibia posteriorly (straight back) relative to the femur

4. Interpretation:

   • Normal: Minimal movement (a firm end-point)

   • Positive Test: Increased posterior translation of the tibia compared to the uninjured side, suggesting a PCL tear

🧠 Tip:

• Always compare both knees (injured vs. uninjured)

• A PCL tear may also cause a “sag sign”—tibia appears sunken back when leg is held up at 90° due to gravity

🦵 1. Lachman’s Test

👉 What it tests:

• Integrity of the Anterior Cruciate Ligament (ACL)

• Most sensitive test for ACL rupture

🧑‍⚕ How to perform:

1. Patient lies supine with the knee in 20–30° of flexion

2. Stabilize the femur with one hand

3. Grasp the proximal tibia with the other hand

4. Gently pull the tibia forward

5. Compare with the opposite side

🧪 Positive result:

• Excessive anterior translation of the tibia

• Soft or absent end-point → ACL tear

🦿 2. Valgus Stress Test

👉 What it tests:

• Integrity of the Medial Collateral Ligament (MCL)

🧑‍⚕ How to perform:

1. Patient lies supine

2. Examiner supports the ankle and applies medially directed force to the lateral knee (push inward)

3. Test at both:

   • 0° (full extension) — tests MCL + capsule + cruciate ligaments

   • 30° flexion — isolates MCL

🧪 Positive result:

• Increased medial joint laxity compared to the other side

• Indicates MCL injury

🦵 3. McMurray’s Test

👉 What it tests:

• Meniscal injury (medial or lateral meniscus)

🧑‍⚕ How to perform:

1. Patient lies supine, hip and knee fully flexed

2. Hold the heel, with one hand on the knee joint line

3. For medial meniscus:

   • Externally rotate the tibia

   • Apply valgus stress

   • Slowly extend the knee

4. For lateral meniscus:

   • Internally rotate tibia

   • Apply varus stress

   • Extend the knee

🧪 Positive result:

• Click, pop, or pain over the joint line

• Indicates meniscal tear