Page 444 - 2021 IDMT Digital

26 Anterior and Posterior With the patient supine and Anterior or posterior
Drawer Test the knee flexed to a 90 degree translation of the tibia more
angle than a few millimeters versus
the uninvolved side with
You sit at the end of the either a soft end point or no
examination table with your end point is a positive test
thigh against the patient’s
toes to restrain the foot A positive test indicates an
anterior cruciate or posterior
You then grasp the tibia just cruciate ligament injury
below the joint line and ask
the patient to relax
If properly relaxed, you pull
forward with both hands
(anterior drawer)
If properly relaxed, you push
backward with both hands
(posterior drawer)
With each test you are
assessing both the amount of
anterior or posterior
translation of the tibia with
respect to the femur and the
quality of the endpoint

27 Valgus and Varus Stress With the patient supine and Pain or a difference in laxity
Tests the knee relaxed, you raise with comparison to the
the patient’s lower limb off uninjured knee is a positive
the examining table by test
grasping it gently at the ankle
Students must verbalize
With the knee if full understanding of the three
extension, you apply a gentle grades of ligament injury
inward force at the knee and
a reciprocating outward force Grade I – MCL/LCL is tender
at the ankle (valgus stress) and swollen but exhibits no
increased laxity
Repeat the same steps with
the knee in 10 to 20 degrees Grade II – MCL/LCL have
of flexion additional finding of increased
laxity to valgus or varus stress
With the patient supine but with a firm endpoint
repeat the same steps in both
extension and flexed position Grade III – MCL/LCL have
but apply a gentle outward additional valgus or varus
force at the knee and an stress with an indefinite
inward force at the ankle endpoint (you feel no
(varus stress) resistance no matter how far
the joint surfaces are
separated)

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