Test	Description
Anterior cruciate ligament tear
Anterior drawer test*	With the patient supine on the examining table, flex the hip to 45° and the knee to 90°. Sit on the dorsum of the foot, wrap 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° externally rotated, and 30° internally rotated. A normal test result is no more than 6 to 8 mm of laxity.
Lachman test*	With the patient supine on the examining table and the leg slightly externally rotated and flexed (20 to 30°) at the examiner's side, stabilize the femur with one hand and apply pressure to the back of the knee with the other hand, with the thumb on the joint line. A positive test result is movement of the knee with a soft or mushy end point.
Pivot shift test*	Fully extend the knee and rotate the foot internally. Apply a valgus (abduction) force while progressively flexing the knee, watching and feeling for translation of the tibia on the femur.
Posterior cruciate ligament tear
Posterior drawer test	The patient should be supine on the examining table with knees flexed to 90°. While standing at the side of the examination table, the physician looks for posterior displacement of the tibia (posterior “sag” sign).4,6,34 The physician then fixes the patient's foot in neutral rotation (by sitting on the foot), positions thumbs at the tibial tubercle, and places fingers at the posterior calf. The physician then pushes posteriorly and assesses for posterior displacement of the tibia.
Gravity “sag” sign near extension test Active reduction “quad activation” of posterior tibial subluxation	In a resting position with the distal femur on a 15-cm support and the heel resting on the examination table (20° of flexion), the unsupported proximal tibia displays a concave anterior contour. When the patient raises the heel 2 to 3 cm, a normal anterior contour is restored.
Meniscal tear
Joint-line tenderness	Palpate medially or laterally along the knee to the joint line between the femur and tibial condyles. Pain on palpation is a positive finding.
McMurray test†	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 or click with pain 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.
Thessaly test‡	Hold patient's outstretched hands while the patient stands flat footed on the floor, internally and externally rotating the affected leg three times with the knee flexed 20°. The unaffected leg should be flexed to avoid contact with the floor. Patient-reported pain at the medial or lateral joint line is a positive finding.
Effusion
Ballottement test§	Push the patella posteriorly with two or three fingers using a quick, sharp motion. In the presence of a large effusion, the patella descends to the trochlea, strikes it with a distinct impact, and flows back to its former position.