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Three Special Tests To Diagnose ACL Injury.

The Lachman, Pivot-Shift, and Anterior Drawer tests are used to diagnose anterior cruciate ligament tears. Studies have indicated that the Lachman test is crucial in diagnosing a severe ACL injury. And also it is considered that better than that of the pivot shift and anterior drawer tests.

Lachman test


Especially to evaluate the integrity associated with the anterior cruciate ligament in the knee.

Test Position: The patient lies down flat on his back, along with legs straight, and the patient should relax the hamstring muscle.

Lachman test
  • The physical therapist flexes your knee slowly and to an angle of 20-degree. Additionally, the therapist rotates your leg so that your knee points outward.
  • The therapist puts one hand on your lower thigh and one hand on your lower leg. Carefully but firmly bring your lower leg forward, maintaining their other hand to stabilize your thigh.

Positive test:

Anterior movement of the tibia which is related to a soft end-feel indicates a positive test. Even more than 2mm of anterior movement of tibia than the uninvolved leg suggests a torn ACL (“soft end-feel”), as does 10mm of complete anterior movement.

Anterior Drawer Test


The purpose of this test is to evaluate the integrity associated with the anterior cruciate ligament tear.

Test Position: Supine.

The patient lies supine on the exam table and flexing the hip and knees to 90°. Also, the feet should be flat on the table (the examiner may sit on the patient’s foot to assure it stays flat).

also, the therapist cups his both hands around your knee using his thumbs in the medial and lateral joint line and hands in the hamstring media and lateral insertions.

Apply a posterior-to-anterior force that is directed to the superior tibia to draw forward towards you. Observe that if the tibia slides ahead (like a drawer) from underneath the femur. Perform the test in the other leg, comparing the amount of forwarding motion.

Anterior drawer test


  • Positive Test:
  1. The tibia jerks forward, showing the contours for the upper tibia, including a lack of end-feel or excessive translation.
  2. An ACL tear is 11.5 times much more likely.
  • Negative Test:
  1. A slight movement is noted.
  2. A couple of examples of forwarding motion are normal if equally present on both sides.

Pivot-Shift Test


To evaluate the integrity of the MCL and ACL (rotary instability ).

Test Position: Supine.

The physical therapist should raise the patient the tested leg off the table with the extended knee. The examiner put the heel of one hand behind the pinnacle fibular head of the client. And grasp the client’s tibia with his other hand while palpating the medial joint line. And directing a valgus force and internal rotation of the tibia during the test. Then slowly flex the client’s knee (note: the test begins by positioning the tibia into the abnormal position)



positive test: The patient lateral tibial plateau begins anteriorly subluxed and go back to normal when you flex the knee to about 30 degrees. 


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