Drawer test

The anterior or posterior drawer test (English Drawer test) is a method of examination in trauma surgery and orthopedics. The drawer test is used together with the Lachman test, the primary clinical diagnosis of rupture of the anterior or posterior cruciate ligament ( cruciate ligament) of the knee joint, by examination of the anterior ( at the front) and posterior (back lying) Translation ( parallel shift ).

Implementation

Usually, the patient being tested has to stop in the supine position the knee in 90 ° flexed position. The drooping Let the lower leg, for example, from the examination table, while avoiding most of the possible sources of error. The bent knee is then with both hands encompasses so by the examiner that the index fingers of both hands are placed behind the knee of the patient. The lower leg will be pulled forward and pushed backward. In the anterior drawer test of the leg on the thigh anteriorly and the posterior drawer test is shifted according to dorsal. The extent of this potential parallel shift - in relation to the non-affected knee - is important for the assessment along with the quality of the end point of the move.

Result

The respective drawer test is considered positive when the leg on the thigh in each direction by more than 0.5 cm is displaced. With a positive anterior drawer then the anterior cruciate ligament is damaged, with a positive posterior drawer the rear. A magnetic resonance imaging ( " MRI " ) or an arthroscopy is then often performed to confirm the diagnosis yet. In the latter, there is also the possibility of surgical treatment in the form of a Kreuzbandteilresektion ( at crack initiation ), a reattachment of the torn- tape to its natural point of attachment or a cruciate ligament reconstruction.

Sources of error

When drawer test is its exact implementation of the reliability of diagnosis is of great importance, since both front and rear cruciate ligament injury can mask each other by the lower leg over the thigh in an unnatural position slips ( ACL tear: forward; HKB plan: to the rear), so you then at " askew knee " the crack of the false cruciate ligament diagnosed. The knee is then supposedly displaced in the direction of the cruciate ligament intact. Therefore, the knee should always be placed in " neutral position " before the test.

Compared to the Lachman test the validity of the drawer test is less.

Medical History

The origin of the drawer test is largely unclear. Paessler and Michel call Paul segund, the first described in 1879 an abnormal mobility of the knee ' as a result of a torn ACL.