Physical Exam

Knee Anterior Drawer

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Video coming September 2026

How to Perform

With the patient supine, the hip flexed to 45° and the knee flexed to 90°, sit lightly on the foot to stabilize it, grasp the upper tibia with both hands, and pull it forward (anteriorly) on the femur. A positive test is increased forward translation compared with the other knee.

How to Interpret

Anterior Cruciate Ligament Tear

Composite anterior cruciate ligament examination positive (Lachman test + anterior drawer test + pivot shift test combined)

Rule in

Very helpful

Rule out

Very helpful

Evidence:Strong

Anterior drawer test positive

Rule in

Helpful

Rule out

Helpful

Evidence:Strong

References

Sokal PA, Norris R, Maddox TW, Oldershaw RA. The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30(10):3287-3303. doi:10.1007/s00167-022-06898-4. PMID: 35150292. PMC9464183 (open access CC BY 4.0). PROSPERO CRD42021231446. PRISMA-compliant systematic review with bivariate random-effects meta-analysis and QUADAS-2 risk-of-bias assessment; 24 studies screened from 33,917 citations (PubMed, Scopus, MEDLINE, Web of Science), 12 studies qualified for bivariate analysis. Reference standards: arthroscopy or MRI. The anterior drawer values cited here are Sokal's published bivariate-model (BA) row from Table 4.
Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL. The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA. 2001 Oct 3;286(13):1610-1620. doi:10.1001/jama.286.13.1610. PMID 11585485. Free DARE summary at NCBI Bookshelf NBK68703. (JAMA Rational Clinical Examination original article.) MEDLINE 1966-Dec 2000 + HealthSTAR 1975-Dec 2000 search; reference standard arthroscopy or open surgery.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.