Posterior Drawer Test
Purpose: To assess the integrity of the PCL.
Test Position: Supine.
Performing the Test: Have the patient's affected hip and knee in a flexed position. The examiner should be seated on the patient's foot of the involved limb. The examiner should place his/her hands along the sides of the affected knee, while palpating the joint line. Apply an anterior-to-posteriorly directed force through the proximal tibia. Be sure to return to the tibia to neutral before assessing the movement. The absence of an end-feel or excessive translation compared to the non-involved side is a positive test.
Diagnostic Accuracy: Sensitivity: .90; Specificity: .99; +LR: 90; -LR: .1 ("The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries").
Importance of Test: The posterior cruciate ligament is responsible for resisting against excessive posterior translation of the tibia on the femur, due to its attachments on posteriorly on the tibial plateau and anteriorly on the lateral side of the medial femoral condyle (Neumann, 2010). A posterior translation force is applied to the proximal tibia, but is blocked by an intact PCL. In the absence of a PCL, the tibia appears to is able to translate excessively. The most common mechanism for PCL injury is posterior translation at 90 degrees of knee flexion. While the PCL can be ruptured through hyperextension and hyperflexion as well, it is unlikely that it is the only ligament torn in these injuries. The ACL has been found to be stressed more than the PCL in both hyperflexion and hyperextension (Ellenbecker, 2000).
Note: these tests should only be used by properly trained health care practitioners
Test Position: Supine.
Performing the Test: Have the patient's affected hip and knee in a flexed position. The examiner should be seated on the patient's foot of the involved limb. The examiner should place his/her hands along the sides of the affected knee, while palpating the joint line. Apply an anterior-to-posteriorly directed force through the proximal tibia. Be sure to return to the tibia to neutral before assessing the movement. The absence of an end-feel or excessive translation compared to the non-involved side is a positive test.
Diagnostic Accuracy: Sensitivity: .90; Specificity: .99; +LR: 90; -LR: .1 ("The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries").
Importance of Test: The posterior cruciate ligament is responsible for resisting against excessive posterior translation of the tibia on the femur, due to its attachments on posteriorly on the tibial plateau and anteriorly on the lateral side of the medial femoral condyle (Neumann, 2010). A posterior translation force is applied to the proximal tibia, but is blocked by an intact PCL. In the absence of a PCL, the tibia appears to is able to translate excessively. The most common mechanism for PCL injury is posterior translation at 90 degrees of knee flexion. While the PCL can be ruptured through hyperextension and hyperflexion as well, it is unlikely that it is the only ligament torn in these injuries. The ACL has been found to be stressed more than the PCL in both hyperflexion and hyperextension (Ellenbecker, 2000).
Note: these tests should only be used by properly trained health care practitioners
References:
Ellenbecker, Todd. Knee Ligament Rehabilitation. Philidelphia, PA: Churchill Livingstone. 20-21. Print
Neumann, Donald. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd edition. St. Louis, MO: Mosby Elsevier, 2010. 536. Print.
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." The American journal of sports medicine. Jul-Aug 1994; 22(4):550-557.
Ellenbecker, Todd. Knee Ligament Rehabilitation. Philidelphia, PA: Churchill Livingstone. 20-21. Print
Neumann, Donald. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd edition. St. Louis, MO: Mosby Elsevier, 2010. 536. Print.
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." The American journal of sports medicine. Jul-Aug 1994; 22(4):550-557.
