Anterior Drawer Test

What is the anterior drawer test?

The anterior drawer test is a set of knee and lower leg movements healthcare providers use to diagnose ACL tears. You’ll lie on your back and your provider will move your lower leg to check how far your knee moves.

The test is part of an in-office physical exam. This means your provider can perform it without any special equipment or a separate appointment. You’ll probably need imaging tests to confirm an ACL tear or any other injuries in your knee joint.

When do healthcare providers perform the anterior drawer test?

A healthcare provider might perform an anterior drawer test if they think you have a torn anterior cruciate ligament (ACL).

The ACL is one of four knee ligaments. Knee ligaments are bands of tissue that connect your thigh bone (femur) to your lower leg bones (tibia and fibula). The ACL stops your knee from moving too far forward or rotating too much.

ACL tears happen when something damages or breaks (ruptures) your ACL. They’re a common sports injury. The most common symptoms of an ACL tear include:

• Knee pain.
• A feeling like your knee is “giving out” (collapsing or buckling).
• Swelling (it might start right away, but can also appear four to six hours later).
• Loss of range of motion in your knee (how far you can move it).
• Tenderness.
• Discomfort when you walk.

How do you perform an anterior drawer test?

The anterior drawer test lets your provider check how far your knee moves, and if parts of it move further than they should. The test includes the following steps:

• You’ll lie on your back (supine).
• Your provider will move your thigh 45 degrees away from the exam table (halfway between flat and fully extended).
• Your provider will bend your knee 90 degrees (perpendicular to your thigh).
• They’ll lean their weight on your foot to hold it in place.
• They’ll hold your lower leg right below your knee.
• Your provider will gently pull your lower leg toward themselves (move it anteriorly).

Your provider might perform an anterior drawer test on your uninjured knee first. This will help them understand your baseline range of motion.

They might also push your lower leg away from themselves and toward the table (posteriorly). Healthcare providers sometimes call this a posterior drawer test, and some perform it at the same time as an anterior drawer test.

If your ACL is torn, your lower leg will move further away from your upper leg than it should. Usually, your ACL connects your lower leg to your thigh and stops it from moving too far. If your ACL is damaged or torn, your lower leg will move more than usual because there’s not as much support holding it in place.

How do I prepare for the anterior drawer test?

You don’t need to do anything to prepare for the anterior drawer test. Visit a healthcare provider as soon as possible after you injure your knee or you notice any symptoms or have trouble moving your knee or leg.

What should I expect during the anterior drawer test?

Try to relax during the test. Your provider will ask you to relax your hamstrings and other leg muscles. Tell your provider how you’re feeling throughout the test, especially if any movement or position hurts a lot or makes your pain worse.

What should I expect after the anterior drawer test?

Your provider might use some imaging tests to confirm an ACL tear. An anterior drawer test is usually very accurate, but imaging tests can show exactly where (and how much) your ACL is torn. You might need:

• Magnetic resonance imaging (MRI).
• Ultrasound.
• X-rays (to check for damage to your bones).

You might also need a knee arthroscopy to diagnose or repair damage inside your knee. Knee arthroscopy is a minimally invasive surgical procedure that lets your surgeon see inside your knee joint with a tiny camera. Most knee arthroscopies are outpatient procedures, meaning you can go home the same day.

Are there any risks to an anterior drawer test?

There are no risks to your knee during an anterior drawer test.

You might feel a little pain or discomfort during the test, but even if your ACL is torn, you shouldn’t feel intense pain.

What type of results will I get and what do they mean?

Anterior drawer test results aren’t as direct as some other tests you might’ve had before. Instead of giving an exact range or a specific number, it tells your provider whether or not your ACL is torn.

It’s more like a true or false question than a math problem that gives an exact answer. Your provider will classify your test as positive if they find anything that indicates your ACL is torn. A negative result means your knee didn’t move further than it should have.

A negative result doesn’t necessarily mean you won’t need other tests. Your ACL might still be torn, or there might be other damage inside your knee.

An anterior drawer test is usually one of many tools your provider will use to diagnose a knee injury. It’s part of their overall, comprehensive exam.

When should I see a healthcare provider?

Visit a healthcare provider if you’ve experienced an injury and have knee pain. Go to the emergency room (ER) if you notice any of the following:

• Extreme pain.
• Swelling that’s getting worse.
• Discoloration.
• You can’t move your knee.

What is the anterior drawer test for ankles?

The anterior drawer test for ankle injuries is similar to the one healthcare providers use to diagnose ACL tears. It’s also called the prone anterior drawer test. Your provider might use it to diagnose an injury to your ankle ligaments. It includes the following steps:

• You’ll lie on your stomach (prone) with your foot hanging over the end of an exam table.
• Your provider will grip your lower leg right above your ankle joint.
• They’ll gently push on the back of your heel toward the floor (anteriorly).

What is the anterior drawer test for shoulders?

The anterior drawer test for shoulders is just like the other types of anterior drawer tests — it helps your provider diagnose injuries or damage in your shoulder joint. An anterior drawer test on your shoulder is slightly different than the tests for your knee or ankle:

• You’ll lie on your back (supine).
• Your provider will hold your arm away from your body (like you’re making one-half of a T shape).
• They’ll support your arm from the bottom with one hand.
• With the other hand, your provider will lightly press on your down on your chest to hold your shoulder blade (scapula) in place.
• Your provider will then gently move your extended arm away from the table (anteriorly).

What is the difference between an anterior drawer test and a Lachman test?

The anterior drawer test and the Lachman test are both physical movement tests that help healthcare providers diagnose ACL tears.

A Lachman test is a variation of the anterior drawer test. Instead of holding your thigh at 45 degrees like you would for an anterior drawer test, your provider will hold your thigh at 20 or 30 degrees (closer to the table you’re lying on).

In an anterior drawer test, your provider will rest their weight on your foot on the table. For a Lachman test, they’ll support the weight of your leg in their hands. Just like an anterior drawer test, your provider will gently pull your lower leg toward themselves (anteriorly) to see how far your knee joint moves.

A note from Cleveland Clinic

The anterior drawer test is a quick, safe way for your healthcare provider to begin diagnosing a torn ACL in your knee. It doesn’t need any special equipment and only takes a few minutes. You might need imaging tests to confirm the results of an anterior drawer test.

Talk to your provider while you’re recovering from an ACL tear. They’ll help you know what to expect and will tell you when it’s safe to get back out on the field or court.