Have you ever had a sudden knee pain while playing, running, or going down a flight of stairs? Did you hear a 'clicking' sound from inside and feel like your knee was going to give out? When you go to a doctor at such a time, one of the methods he uses to examine your knee is called the `Anterior Drawer Test`. Let's see what it is, how it is done, and whether there is anything to be afraid of.
What is the Anterior Drawer Test?
Simply put, the Anterior Drawer Test is a special procedure where a doctor manually examines your knee. This mainly checks to see if the anterior cruciate ligament (ACL) in your knee is damaged, meaning it's torn.
Imagine, inside our knee, there are strong bands that connect the thigh bone (Femur) and the shin bone (Tibia). We call these ligaments `(Ligaments).` These are what keep the knee stable and from jumping around unnecessarily. `ACL` is one of these ligaments. To be precise, this `ACL` stops your shin bone from jumping forward unnecessarily in relation to the thigh bone.
In the Anterior Drawer Test, your doctor will pull your knee forward several times. If your ACL is torn, the knee will protrude more than normal. This is similar to the way a door can be opened easily when the lock is broken. This is a simple test that can be done in the office and does not require any special equipment.
What time does the doctor do this test?
If you have a knee injury and have the following symptoms, your doctor may suspect damage to the ACL. This test may be done.
| Common symptoms of an ACL injury | Description |
|---|---|
| Knee pain | Severe pain that occurs immediately after the injury or shortly thereafter. |
| Feeling like the knee is "going out of control" | When standing or walking, the knee suddenly bends and feels like it is going out of control. |
| Swelling | The knee may swell within minutes or 4-6 hours after the injury. |
| Restriction of movement | Inability to fully extend or bend the knee. |
| Difficulty walking | Feeling pain or unsteadiness when walking. |
How to do the Anterior Drawer Test correctly?
This is a very simple procedure that you won't feel much pain. Imagine that you are lying face up on an exam table.
| Steps | What is happening? |
|---|---|
| 1. Adjusting the posture | After you lie on your back, the doctor will elevate your thigh about 45 degrees. |
| 2. Knee bend | Next, bend your knee 90 degrees, that is, at a right angle, and place your foot on the bed. |
| 3. Stabilizing the foot | The doctor will sit on your leg with a little of his weight and stabilize it to the bed. |
| 4. Pulling forward | Now the doctor will use both of his hands to grab the top of your pelvis, just below your knee, and very gently pull it towards him, that is, forward. |
Most of the time, the doctor will first perform this test on your healthy knee, which is not affected . This is to get an idea of what your knee's normal range of motion is like. Then, the affected knee will be examined. Then, you can clearly see the difference between the two.
What happens during and after the test?
It is important that you remain as still as possible during this test. Your doctor will tell you to keep your leg muscles, especially the hamstrings, relaxed. If you feel any pain during any movement, tell your doctor.
The most important thing is that this test will not cause any additional damage to your knee. Even if the ACL is torn, it will not cause much pain. So don't be afraid.
After the Anterior Drawer Test, if an ACL tear is suspected, the doctor may recommend several more tests to confirm it.
- MRI (Magnetic Resonance Imaging) Scan: This can clearly see damage to soft tissues such as ligaments and meniscus (cushion-like parts).
- X-ray: This is used to check for damage to the bones, such as a fracture.
- Ultrasound scan: This is also used in some cases.
You may also need to have a minor surgery called a knee arthroscopy to look at or repair damage inside the knee. This involves inserting a small camera into the knee. This is usually a same-day procedure.
How to read the test results?
The result of this is not a number like the answer to a math problem. It's more like saying 'yes' or 'no'.
- Positive Result: If when the doctor pulls your knee forward, it comes forward more than a healthy knee, it means that the ACL may be torn.
- Negative Result: If there is no abnormal movement of the knee, the result is negative.
But remember, even if the result is negative, it does not mean that the ACL is 100% free of damage. It is possible that another ligament or other part of the knee is damaged. That is why the Anterior Drawer Test is only one part of the complete testing process.
When should I see a doctor?
If you have a knee injury and are in pain, see a doctor immediately. However, if you have any of the following, go to a hospital's Emergency Treatment Unit (ETU) immediately.
| Red Flags When You Should Go to the Hospital Immediately | |
|---|---|
| Severe pain | The pain is unbearable. |
| Worsening swelling | If the swelling in the knee is gradually increasing. |
| Color change | If the skin around the knee turns blue or purple. |
| Inability to move | If you can't move your knee at all. |
Are there tests like this for other joints?
Yes, the same methods as the Anterior Drawer Test are also used to test for ankle and shoulder ligament injuries. The test position varies slightly depending on the location of each joint.
What is the difference between the Anterior Drawer Test and the Lachman Test?
The `Lachman Test` is another very popular method used to test for `ACL` tears. The main difference between the two is the amount of knee flexion during the test.
- Anterior Drawer Test: The knee is bent 90 degrees and tested.
- Lachman Test: The knee is tested by bending it slightly, about 20-30 degrees.
Doctors may use either or both of these tests when they suspect an ACL injury.
Take-Home Message
- The `Anterior Drawer Test` is a simple, quick, manual test that a doctor performs to check for damage to the `ACL` ligament in the knee.
- There is no need to be afraid of this test. It will not cause you any significant pain or further damage to your knee.
- This is just one step in the entire diagnostic process. Often, the disorder is confirmed by doing something like an MRI scan.
- If you have a serious knee injury, severe pain, swelling, or inability to move your leg, see a doctor immediately or go to a hospital's Emergency Department (ETU).
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