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The Lachman Test
An examiner who is skilled can often times detect an injury in your knee before ordering other tests like an MRI or an x-ray. One such manual test is the Lachman test. Named after John Lachman, M.D., the Lachman test is performed to test a person's ACL for stability. More specifically, the goal of this test is to help determine if the ACL has been torn or if it is still intact.
To perform the Lachman test, the patient should be laying supine (on their back) with their knee in approximately 20-30 degrees of flexion. The leg that is being tested should also be externally rotated. The individual conducting the maneuver needs to place one hand on the patient's thigh, while the other hand needs to be placed behind the tibia, with one thumb placed on the tibial tuberosity. The examiner pulls anteriorly on the tibia to determine forward translation of the tibia on the femur. (The tibia is the larger of the two bones in the leg, while the femur is the thigh bone.) When pulling anteriorly on the tibia, an intact ACL should prevent forward translation movement of the tibia on the femur. This is known as a "firm endpoint". On the other hand, if the end point is "soft", and the tibia can move forward on the femur, then this suggests that the ACL is torn.
The Anterior Drawer Test
A second commonly used test, among several, to determine the stability of the ACL is the Anterior Drawer Test. In this test, the patientis lying supine (on their back) with their hips flexed to 45 degrees and their knee to 90 degrees. The individual performing the test then grasps the tibia just below the knee, with their thumbs on either side of the patellar tendon. It is important to note that the hamstring muscle group must remain relaxed to help ensure a proper test. (The index fingers can be used, by the examiner, to test the hamstrings). Once the examiner is in position, the tibia is then drawn forward anteriorly. When the examiner notes that one side has increased amount of anterior tibial translation compared to the opposite limb, this will help indicate whether an ACL injury has occured.
If these tests are positive and the ACL is sprained, or can be torn. Depending on the severity of the injury, a knee brace can help provide meaningful stability, and can help reduce pain as well. These knee braces are widely used among sporting professionals with previous ACL injuries, and can aid individuals to help get moving again with confidence.
Reference : Starkey, C., & Ryan, J. (2003). The Knee. Orthopedic & Athletic Injury Evaluation Handbook (pp.106). F.A. Davis Company
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