Accuracy of Lachman and Anterior Drawer Tests for Anterior Cruciate Ligament Injuries

Document Type : RESEARCH PAPER


Department of Orthopedic Surgery, Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran.


The knee joint is prone to injury because of its complexity and weight-bearing function. Anterior cruciate ligament (ACL) ruptures happen in young and physically active population and can result in instability, meniscal tears, and articular cartilage damage. The aim of this study is to evaluate the accuracy of Lachman and anterior drawer test in ACL injury in compare with arthroscopy.
In a descriptive, analytical study from 2009 to 2013, 653 patients who were suspected to ACL rapture were entered the study. Statistical analysis was performed by the usage of SPSS 19.0. Multiple comparison procedure was performed for comparing data between clinical examination and arthroscopic findings and their relation with age and sex.
Mean age of patients was 28.3±7.58 years (range from 16 to 68 years). From 428 patients, 41.2% (175 patients) were between 26 and 35, 38.8% (165 ones) between 15 and 25 and 20% (85 patients) over 36 years. 414 patients were male (97.2%) and 12 were female (2.8%). Sensitivity of anterior drawer test was 94.4% and sensitivity of Lachman test was 93.5%.
The diagnosis and decision to reconstruct ACL injury can be reliably made regard to the anterior drawer and Lachman tests result. The tests did not have privilege to each other. These test accuracy increased considerably under anesthesia especially in women.


  1. Calmbach WL, Hutchens M. Evaluation of patients presenting with knee pain: part I. History, physical examination, radiographs, and laboratory tests. Am Fam Physician. 2003;68(5):907-12.

  2. Cimino F, Volk BS, Setter D. Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician. 2010;82:917-22.

  3. Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee liga¬ment injuries: a national population-based study. J Sci Med Sport.  2009;12(6):622-7.

  4. Honkamp NJ, Shen W, Okeke N, Ferretti M, Fu FH. Anterior cruciate ligament injuries: 1. Anterior cruciate ligament injuries in the adult. In: DeLee JC, Drez D Jr, Miller MD, editors. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia: Saunders Elsevier; 2009.

  5. Mulligan EP, Harwell JL, Robertson WJ. Reliability and diagnostic accuracy of the Lachman test performed in a prone position. J Orthop Sports Phys Ther. 2011;41(10):749-57.

  6. Floyd RT, Peery DS, Andrews JR. Advantages of the prone Lachman versus the traditional Lachman. Orthopedics. 2008;31(7):671-5.

  7. Konishi Y, Oda T, Tsukazaki S, Kinugasa R, Hirose N, Fukubayashi T. Relationship between quadriceps femoris muscle volume and muscle torque after anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):641-5.

  8. Cimino F, Volk BS, Setter D. Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician. 2010;82(8):917-22.

  9. Shelbourne KD. The art of the knee examination: where has it gone?. J Bone Joint Surg Am. 2010;92(9):e9.

  10. Sonnery-Cottet B, Barth J, Graveleau N, Fournier Y, Hager JP, Chambat P. Arthroscopic identification of isolated tear of the posterolateral bundle of the anterior cruciate ligament. Arthroscopy. 2009;25(7):728-32.

  11. Dejour D, Ntagiopoulos PG, Saggin PR, Panisset JC. The diagnostic value of clinical tests, magnetic resonance imaging, and instrumented laxity in the differentiation of complete versus partial anterior cruciate ligament tears. Arthroscopy. 2013;29(3):491-9.

  12. van Eck CF, van den Bekerom MP, Fu FH, Poolman RW, Kerkhoffs GM. Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Knee Surg Sports Traumatol Arthrosc. 2013;21(8):1895-903.

  13. Oberlander MA, Shalvoy RM, Hughston JC. The accuracy of the clinical knee examination documented by arthroscopy. Am J Sports Med. 1993;21:773–7.

  14. Benjaminse A, Gokeler A, Van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: A meta-analysis. J Orthop Sports Phys Ther. 2006;36:267–88.

  15. Jain DK, Amaravati R, Sharma G. Evaluation of the clinical signs of anterior cruciate ligament and meniscusal injuries. Indian J Orthop. 2009;43(4):375-8.

  16. Liu SH, Osti L, Henry M, Bocchi L. The diagnosis of acute complete tears of the anterior cruciate ligament. Comparison of MRI, arthrometry and clinical examination. J Bone Joint Surg Br. 1995;77(4):586-8.

  17. Araki D, Kuroda R, Kubo S, Nagamune K, Hoshino Y, Nishimoto K, Takayama K, Matsushita T, Tei K, Yamaguchi M, Kurosaka M. The use of an electromagnetic measurement system for anterior tibial displacement during the Lachman test. Arthroscopy. 2011;27(6):792-802.

  18. Peeler J, Leiter J, MacDonald P. Accuracy and reliability of anterior cruciate ligament clinical examination in a multidisciplinary sports medicine setting. Clin J Sport Med. 2010;20(2):80-5.

  19. Jonsson T, Althoff B, Peterson L, Renström P. Clinical diagnosis of ruptures of the anterior cruciate ligament A comparative study of the Lachman test and the anterior drawer sign. Am J Sports Med. 1982;10(2):100-2.