OnExam

Assesses for instability of the anterior cruciate ligament (ACL).

Performing the Test

  1. Patient supine, knee relaxed in 15°-30° of flexion
  2. Grasp distal femur with left hand, proximal tibia with right, ensuring left thumb is on joint line
  3. Stabilizing femur, apply anterior pressure to posterior tibia
  4. Positive: greater anterior tibial displacement on affected side compared to unaffected side
  5. Compare both knees
  6. Sensitivity: 87%; specificity: 60%
  7. LR+ = 9.4; LR- = 0.23

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.