Physical examination for ACL rupture

Lachman test
Anterior drawer test
Pivot shift test
Objective test

 Lachman test 

Most reliable exam (95% sensitivity)

Useful in swollen and painful condition

15-30° knee flexion

Check contralateral normal side first

Palpated by thumb

Grade 0 < 3mm Grade I 3-5mm, Grade II 6-10mm, Grade III>10mm 

compared with the opposite


Anterior drawer test

False positive d/t PCL insufficiency

False negative d/t “doorstop” effect of MPH







Check antero-medial/lateral rotatory instability

Slocum anterior rotatory drawer test

ER 30° / IR 15°


Pivot-shift test

Valgus + IR with intact MCL/ITB

Chronic or Acute under anesthesia

During Ext. to Flex. 30° 

ITB reduces lateral tibial condyle

Grade 1  Gliding 

Grade 2  Jumping(abrupt reduction)

Grade 3  Momentarily locking


Objective test

Arthrometer (KT-1000/2000)

Similar fashion to the Lachman test

SSD ≥ 3mm: 90% of ACL rupture


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