Evaluation: some basics and guidelines

*Anterior drawer test (Top left for ?acl injury). Place patient supine, flex the hip to 45 degrees and the knee to 90 degrees. Sit on the dorsum of the foot, wrap your hands around the hamstrings (ensuring that these muscles are relaxed), then pull and push the proximal part of the leg, testing the movement of the tibia on the femur. Do these maneuvers in three positions of tibial rotation: neutral, 30 degrees externally rotated, and 30 degrees internal rotated. A normal test result is no more than 6 mm to 8 mm of laxity.

**Lachman test (Top right for ?acl injury). Place patient supine on examining table, leg at the examiner's side, slightly externally rotated and flexed (20 to 30 ~grees). Stabilize the femur with one hand, and apply pressure to the back of the knee with the other hand with the thumb of the hand exerting pressure placed on the joint line. A positive test result is movement of the knee with a soft or mushy end point.

***Pivot test (Bottom left for ?acl injury). Fully extend the knee, rotate the foot internally. Apply a valgus stress while prógressively flexing the knee, watching and feeling for translation of the tibia on the femur.

McMurray test (Bottom right for ?meniscal injury). Flex the hip and knee maximally. Apply a valgus (abduction) force to the knee while externally rotating the foot and passively extending the knee. An audible or palpable snap during extension suggests a tear of the medial meniscus. For the lateral meniscus, apply a varus (adduction) stress during internal rotation of the foot and passive extension of the knee.