Glossary
Anterior drawer test
Quick answer
The anterior drawer test checks the anterior cruciate ligament by bending the knee to 90 degrees, steadying the foot and pulling the top of the shin forward like opening a drawer. Excess forward movement suggests an ACL tear, says Dr. Pablo Gelber, knee surgeon at Aman Hospital in Doha, who uses it alongside the Lachman test.
What happens during the test
You lie on your back with the knee bent to a right angle and the foot flat on the couch. The surgeon sits lightly on your foot to keep it still, wraps both hands around the top of the shin and gently pulls it forward, then pushes it back.
It feels like a rocking or sliding movement of the shin under the thigh. It is rarely painful once the hamstring muscles are relaxed.
What it tells the surgeon
If the shin slides forward much more than on the healthy side, the ACL is probably torn or stretched. Turning the foot in or out during the test can also hint at injury to the structures on the inner or outer corners of the knee.
The drawer test is less sensitive than the Lachman test in a fresh injury, because a swollen knee may not bend to 90 degrees and the hamstrings can hold the shin back. It is more useful in older injuries and as a cross-check.
Why the starting position matters
If the PCL at the back of the knee is torn, the shin sags backwards at rest. Pulling it forward then looks like a positive drawer test when it is actually the shin returning to neutral. Surgeons check for this sag first to avoid confusing a PCL injury with an ACL tear.
Frequently asked questions
Is the anterior drawer test the same as the Lachman test?
Both test the ACL by moving the shin forward. The Lachman test uses a slightly bent knee and is usually more accurate in a fresh injury; the drawer test uses a knee bent to 90 degrees.
Do I still need an MRI if the drawer test is positive?
Often yes. The examination suggests the diagnosis, and an MRI usually confirms it and shows any meniscus, cartilage or bone injury that affects treatment.
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