{"id":1246,"date":"2010-12-04T14:54:18","date_gmt":"2010-12-04T14:54:18","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/cruciate-ligaments\/"},"modified":"2023-11-23T17:32:38","modified_gmt":"2023-11-23T17:32:38","slug":"cruciate-ligaments","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-lower-extremities\/the-knee\/cruciate-ligaments\/","title":{"rendered":"Cruciate Ligaments"},"content":{"rendered":"<hr \/>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #003366;\"><strong>Lachman Test<\/strong><\/span><\/span><\/h3>\n<p><span style=\"color: #003366;\">This test is indicated in the case of:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Substantial fluid accumulation (<em>and\/or hemarthrosis<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Acute \u2018traumas\u2019 (<em>limited flexion possibilities<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Chronic instability. This test has proven to be more specific than the drawer sign at 90\u00b0.<\/span><\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/124602334?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">The patient lies in supine position with both knees flexed at about 15\u00b0.<\/span><\/li>\n<li><span style=\"color: #003366;\">Stand on the side of the leg to be tested. <\/span><\/li>\n<li><span style=\"color: #003366;\">Take hold of the distal femur with one hand and the proximal tibia with the other <em><strong>[Figure 80]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Now examine the forwards and backwards mobility of the tibia on the femur.<\/span><\/li>\n<li><span style=\"color: #003366;\">Note:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Abnormal mobility in the forwards or backwards direction.<\/span><\/li>\n<li><span style=\"color: #003366;\">Pain.<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscular defence.<\/span><\/li>\n<li><span style=\"color: #003366;\">Left\/right differences.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #003366;\"><strong>Drawer Sign<\/strong><\/span><\/span><\/h3>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">The patient lies in supine position, with the knees in 90\u00b0 flexion and the feet flat on the examination table.<\/span><\/li>\n<li><span style=\"color: #003366;\">Stand on the side of the knee to be tested. <\/span><\/li>\n<li><span style=\"color: #003366;\">Place the fingers of both hands in the back of the knee, with the index fingers registering the tension of the hamstrings and the thumbs lying vertically on the joint space (<em>next to the patellar ligament<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Stabilise the patient\u2019s foot by sitting on it with your thigh.<\/span><\/li>\n<li><span style=\"color: #003366;\">Slowly pull the proximal tibia ventrally with respect to the femur (<em>anterior drawer test<\/em>) <em><strong>[Figure 81]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1241\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-81.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-81.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-81-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 81<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Note:<\/span>\n<ul>\n<li><span style=\"color: #003366;\">Abnormal mobility forwards.<\/span><\/li>\n<li><span style=\"color: #003366;\">Pain.<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscular defence.<\/span><\/li>\n<li><span style=\"color: #003366;\">Left \/right differences.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #003366;\">If abnormal forwards mobility is observed, the anterior drawer test is <span style=\"color: #33cccc;\"><strong>positive<\/strong><\/span>.<\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Repeat the <span style=\"color: #33cccc;\"><strong>anterior drawer test<\/strong><\/span> with the lower leg stabilised in maximum exorotation<em><strong> [Figure 82]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Note the points listed above. <\/span><\/li>\n<li><span style=\"color: #003366;\">Normally, if the capsule is intact, any instability established in the neutral position should decrease during <span style=\"color: #33cccc;\"><strong>exorotation<\/strong><\/span> and\/or <span style=\"color: #33cccc;\"><strong>endorotation<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">If not, the instability will remain the same or even increase. <\/span><\/li>\n<li><span style=\"color: #003366;\">A positive anterior drawer test in this position means that in addition to a disorder of the anterior cruciate ligament, a condition involving the <span style=\"color: #33cccc;\"><strong>postero-medial capsule<\/strong><\/span> and\/or the <span style=\"color: #33cccc;\"><strong>ligament structures<\/strong><\/span> is likely.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1242\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-82.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-82.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-82-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 82<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Repeat the anterior drawer test with the lower leg stabilised in maximum endorotation <em><strong>[Figure 83]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Note the points listed above.<\/span><\/li>\n<li><span style=\"color: #003366;\">A positive anterior drawer test in this position means that a condition involving the postero-lateral capsule and\/or the ligament structures is likely.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1243\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-83.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-83.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-83-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 83<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Bring the lower leg into the middle position once again and slowly push the proximal tibia dorsally with respect to the femur (\u2018<em>posterior drawer test<\/em>\u2019). <\/span><\/li>\n<li><span style=\"color: #003366;\">Note the previously-listed points.<\/span><\/li>\n<li><span style=\"color: #003366;\">If there is any abnormal mobility in the posterior direction, it is referred to as a <span style=\"color: #33cccc;\"><strong>positive posterior drawer test<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">In that case, a condition involving the posterior cruciate ligament is likely. <\/span><\/li>\n<li><span style=\"color: #003366;\">A positive posterior drawer test may not be observed in the case of an injury to the posterior cruciate ligament if the tibia is located too far dorsally.<\/span><\/li>\n<li><span style=\"color: #003366;\">This gives a <span style=\"color: #33cccc;\"><strong>false-negative posterior drawer test<\/strong><\/span> and a <span style=\"color: #33cccc;\"><strong>false-positive anterior drawer test<\/strong><\/span>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"text-decoration: underline;\"><span style=\"color: #003366;\"><strong>Posterior Sag Sign (Gravity Drawer Test)<\/strong><\/span><\/span><\/h3>\n<p><span style=\"color: #003366;\">This test is indicated in the case of:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">A positive posterior drawer test.<\/span><\/li>\n<li><span style=\"color: #003366;\">A positive anterior drawer test.<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #003366;\">If there is a <span style=\"color: #33cccc;\"><strong>posterior cruciate ligament rupture<\/strong><\/span>, the tibia might drop down slightly and a false-positive anterior drawer test may be found.<\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">The patient lies in supine position.<\/span><\/li>\n<li><span style=\"color: #003366;\">Bring both hips and knees into 90\u00b0 flexion while supporting both lower legs.<\/span><\/li>\n<li><span style=\"color: #003366;\">Stand at the foot end <em><strong>[Figure 84a]<\/strong> <\/em>and\/or the side<em><strong> [Figure 84b]<\/strong><\/em> of the knee concerned and, with the eyes at knee height, inspect the contours of the tibial tuberosities of both knees. <\/span><\/li>\n<li><span style=\"color: #003366;\">If the tibial tuberosity of the knee concerned sinks dorsally in this position, there is an injury to the posterior cruciate ligament.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1244\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-84a.jpg\" alt=\"\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-84a.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-84a-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 84a<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1245\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-84b.jpg\" alt=\"\" width=\"400\" height=\"293\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-84b.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/LowerExtrem_le-fig-84b-300x220.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 84b<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Lachman Test This test is indicated in the case of: Substantial fluid accumulation (and\/or hemarthrosis). Acute \u2018traumas\u2019 (limited flexion possibilities). Chronic instability. This test has proven to be more specific than the drawer sign at 90\u00b0. Procedure The patient lies in supine position with both knees flexed at about 15\u00b0. Stand on the side of [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[70],"tags":[144],"class_list":["post-1246","post","type-post","status-publish","format-standard","hentry","category-the-knee","tag-the-examination-of-the-lower-extremities"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Cruciate Ligaments - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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