OnExam

Assesses anterior cruciate ligament (ACL) stability.

Performing the Test

  1. Patient supine, hip flexed to 45°, knee flexed to 90°, with foot flat and stabilized
  2. Grasp knee with both hands just distal to patella, with thumbs on joint line
  3. Pull tibia forward on femur in the direction of the joint line (not directly towards examiner), ensure hamstrings are relaxed and appreciate end feel, compare both knees
  4. Positive: anterior displacement ≥1.5 cm
  5. False positive when there is a posterior sag sign
  6. Sensitivity: 48%; specificity: 87%
  7. LR+ = 3.7; LR- = 0.6

References

  1. Pawa J, Lesniak, D., & Lott, A. Approach to the OSCE: The Edmonton Manual of Common Clinical Scenarios. Edmonton Manual; 2011.
  2. Baxter S, ed., McScheffrey G, ed. Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & USMLE 2. 26th ed. Toronto: Toronto Notes for Medical Students Inc; 2010.
  3. Bickley L. Bate’s Guide to Physical Examination and History Taking. 10th ed. New York: Lippincott Williams & Wilkins; 2009.
  4. Essential Evidence Plus. http://www.essentialevidenceplus.com. 2011. Accessed February 2011.
  5. Hurley K. OSCE and Clinical Skills Handbook. Halifax: Elsevier Canada; 2005.
  6. Levy DB, Soft Tissue Knee Injury. Emedicine from WebMD. http://emedicine.medscape.com/article/826792-overview. 2009. Accessed February 2001.
  7. Magee D. Orthopedic Physical Assessment. 1st ed. Philadelphia:Saunders; 1986.