Posterior Drawer Test of the Knee

 Posterior Drawer Test of the Knee

What is the posterior drawer test used for?

Posterior Drawer Test of the Knee is used to evaluate the integrity of the posterior cruciate ligament (PCL) of the knee.

It’s a test for PCL injury.

How do you test for PCL injury?

The test is done in neutral position of the foot, in internal rotation and external rotation position of the foot.

Posterior Drawer Test
Posterior Drawer Test

What does a positive Posterior Drawer Test of the Knee mean?

Sensitivity & Specificity

In a blinded, randomized, and controlled study1 involving 39 patients to assess the clinical examination skills of orthopaedic surgeons with fellowship training in sports medicine, Rubinstein et al. reported that the accuracy for detecting a PCL tear was 96%, with a 90% sensitivity and a 99% specificity.

The examination accuracy was higher for grades II and III posterior laxity than for grade I laxity. Eighty-one percent of the time, the examiners agreed on the grade of the PCL tear for any given patient.

Notes

Functional Posterior Drawer Test2

Functional Posterior Drawer Test
Functional Posterior Drawer Test of the knee

Posterior Cruciate Ligament Injury

This most commonly results from a direct bow to the upper tibia in a flexed knee-dashboard injury or hyperflexion without a blow or in frank dislocation.

Loss of confidence in the knee and giving way feeling may be present.

Positive posterior sagging, posterior drawer test, external rotation recurvatum test and posterolateral instability tests may be present.

Posterior Drawer Test

Reference

  1. Rubinstein RA Jr, Shelbourne KD, McCarroll JR, VanMeter CD, Rettig AC. The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med. 1994 Jul-Aug;22(4):550-7. doi: 10.1177/036354659402200419. PMID: 7943523.
  2. Shino K, Horibe S, Ono K. The voluntarily evoked posterolateral drawer sign in the knee with posterolateral instability. Clin Orthop Relat Res. 1987 Feb;(215):179-86. PMID: 3802636.
  3. Clinical Tests for the Musculoskeletal System 3rd Edition.
  4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
  5. Sarvdeep S. Dhatt, Sharad Prabhakar – Handbook of Clinical Examination in Orthopedics.

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