Execution
- 1Position the patient supine with the hip flexed to 45 degrees and the knee flexed to 90 degrees.
- 2Sit on or stabilizes the patient's foot to prevent movement.
- 3Grasp the proximal tibia with both hands just below the joint line.
- 4Ensure the hamstrings are relaxed and note any posterior sag before testing.
- 5Pull the tibia anteriorly and compare translation and end feel with the opposite side.
Positive outcome
Excessive anterior translation or a soft end point is positive for ACL injury. If a posterior sag is present before the test, the tibia may first move back to neutral and falsely mimic anterior drawer. Hamstring guarding can create false negatives.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Benjaminse et al. (2006) | meta-analysis | 62 | 88 | 3.7 | 0.5 |
| van Eck et al. (2013) | systematic review/meta-analysis | 38 | 81 | 2.0 | 0.77 |
CommentMagee emphasizes the need to identify posterior sag before interpreting anterior drawer. The test is less sensitive than Lachman, especially acutely because pain and hamstring spasm limit anterior translation. It remains useful as part of a ligament exam but is not the best stand-alone ACL test.
Moderate Clinical Value