A knee-at-90-degrees test of anterior cruciate laxity.
The anterior drawer test is a manual orthopaedic test used to assess the integrity of the anterior cruciate ligament (ACL) by evaluating how far the tibia translates forward on the femur. It is performed with the knee flexed to 90 degrees, and the amount and quality of anterior movement is compared against the uninjured limb.
It gives the clinician an immediate, hands-on indication of ACL competence that feeds directly into decisions about further imaging, referral for orthopaedic opinion, and early management of a suspected knee injury. Establishing side-to-side asymmetry in translation, along with the quality of end-feel, helps frame the conversation with the patient about likely structures involved and expected rehabilitation trajectory.
With the patient supine and the hip flexed around 45 degrees and knee flexed to 90 degrees, the examiner stabilises the foot, wraps both hands around the proximal tibia, and applies a firm anterior pull while palpating hamstring relaxation. The examiner notes the distance of translation and the character of the end-point (firm versus soft/mushy), then repeats the manoeuvre on the contralateral knee for comparison.
Sensitivity is reduced in the acute setting due to guarding, effusion, hamstring spasm, and pain inhibition, meaning a negative test soon after injury does not reliably rule out an ACL tear. It can also be confounded by posterior cruciate ligament injury, which allows the tibia to rest posteriorly and produces a false-positive anterior translation when reduced to neutral; the Lachman test is generally regarded as more sensitive for acute ACL assessment.
This guide was auto-drafted and is pending editorial review.