Common Maneuvers of the Knee for Assessing Possible
Ligamentous and Meniscal Damage 
Anterior drawer test (Top
left). Place patient supine, flex the hip to 45 degrees and the knee to 90
degrees. Sit on the dorsum of the foot, wrap your hands around the hamstrings
(ensuring that these muscles are relaxed), then pull and push the proximal part
of the leg, testing the movement of the tibia on the femur. Do these maneuvers
in three positions of tibial rotation: neutral, 30 degrees externally rotated,
and 30 degrees internally rotated. A normal test result is no more than 6 mm to
8 mm of laxity.
Lachman test (Top right). Place patient supine on examining
table, leg at the examiner's side, slightly externally rotated and flexed (20
to 30 degrees). Stabilize the femur with one hand, and apply pressure to the
back of the knee with the other hand with the thumb of the hand exerting
pressure placed on the joint line. A positive test result is movement of the
knee with a soft or mushy end point.
Pivot test (Bottom left). Fully extend the knee, rotate
the foot internally. Apply a valgus stress while progressively flexing the
knee, watching and feeling for translation of the tibia on the femur.
McMurray test (Bottom right). Flex the hip and knee
maximally. Apply a valgus (abduction) force to the knee while externally
rotating the foot and passively extending the knee. An audible or palpable snap
during extension suggests a tear of the medial meniscus. For the lateral
meniscus, apply a varus (adduction) stress during internal rotation of the foot
and passive extension of the knee.
Adapted with permission from
Jackson JL, O'Malley PG, Kroenke K. Evaluation of acute knee pain in primary
care. Ann Intern Med 2003;139:580. |
