How do you perform a Lachman test?
0:131:16Lachman Test | Anterior Cruciate Ligament (ACL) Rupture KneeYouTubeStart of suggested clipEnd of suggested clipSo to do that we need to stabilize the thigh we need to make sure martin's nice and relaxed. And we'MoreSo to do that we need to stabilize the thigh we need to make sure martin's nice and relaxed. And we're trying to move the tibia anteriorly relative to the femur. So we grab the tibia.
What is a positive Lachman test?
A positive Lachman test or pivot test is strong evidence of an existing anterior cruciate ligament (ACL) tear, and a negative Lachman test is fairly good evidence against that injury. Although widely used, the anterior drawer is the least helpful maneuver for diagnosing an ACL tear.
Can Lachman test tear the ACL?
Conclusion. The prone Lachman test is a reliable evaluation technique that can be used to confirm the presence of an ACL tear; however, the test should not be used as the sole criterion to rule out the presence of the injury.
Why was a Lachman test performed?
The Lachman test is a specific clinical exam technique used to evaluate patients with a suspected anterior cruciate ligament (ACL) injury. The test relies on proper positioning and technique and is regarded as the most sensitive and specific test for diagnosing acute ACL injuries.
Can you walk on a torn ACL?
Can you walk with a torn ACL? The short answer is yes. After the pain and swelling subsides and if there is no other injury to your knee, you may be able to walk in straight lines, go up and down stairs and even potentially jog in a straight line.
How do you tell if ACL is torn or sprained?
Signs and symptoms of an ACL injury usually include:A loud "popping" in the knee.Severe pain.Rapid swelling.Loss of range of motion.Knee instability where the knee feels like it will buckle and cannot support the weight.
Do all ACL tears require surgery?
While complete ACL tears almost always require surgery, partial ACL tears may be treated effectively with nonsurgical methods. ACL tears are graded by severity and are called sprains (a sprain is a stretch or tear in a ligament). A grade 1 ACL sprain occurs when your ACL is overstretched, but not torn.
What are the 2 most popular tests for the ACL?
The anterior Lachman test, anterior drawer test and the pivot shift test, which are summarised in Table 1, are the most commonly known physical tests used to assess the integrity of the ACL (Benjaminse 2006; Leblanc 2015; Malanga 2003; Scholten 2003; Solomon 2001).
What is the difference between an ACL rupture and tear?
An ACL injury may be diagnosed when the ligament is overstretched or torn. The tear may be partial or complete; a complete tear of the ACL is also known as an ACL rupture.
Can you still walk with a torn ligament in your knee?
In most cases, the injured person can still walk with the torn knee ligament. But the movement will be severely limited, not to mention painful. Surgery may be the best route to a pain-free life, with amazing success rates.
How long does it take for a torn ligament in your knee to heal?
On average, these injuries take six weeks to heal. No matter the grade of the tear, initial treatment focuses on immobilizing the knee and reducing pain and inflammation. Measures include: Resting, icing and elevating the knee.
How can you tell if you tore a ligament in your knee?
Pain, often sudden and severe. A loud pop or snap during the injury. Swelling within the first 24 hours after the injury. A feeling of looseness in the joint.
What does a positive anterior drawer test indicate?
If the tibia, or shinbone, has more movement, or if the ligament is loose compared with the other knee, the anterior drawer test is considered to be positive. Your physical therapist might suggest that you see your doctor for imaging like a magnetic resonance imaging (MRI).
Does a Grade 2 ACL require surgery?
ACL tears, even at grade 2, may warrant surgery if pain is severe. Lifestyle: If you have a partial tear and lead a relatively sedentary lifestyle, you may not need surgical reconstruction. Growth plates: If your growth plates are still open (only applicable to children), surgery may not be required for a partial tear.
Why is Lachman test done at 30 degrees?
The Lachman's test is performed between 20°-30° of knee flexion, which helps to isolate the affect of the ACL providing stability to anterior translation of the knee.
How is an ACL tear diagnosed?
An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage. Ultrasound. Using sound waves to visualize internal structures, ultrasound may be used to check for injuries in the ligaments, tendons and muscles of the knee.
What is the Lachman test?
The Lachman test is a physical examination maneuver used to assess the integrity of the anterior cruciate ligament in a suspected anterior cruciate ligament (ACL) injury. The test is used to evaluate the anterior translation of the tibia in relation to the femur and is considered a variant of the anterior drawer test. Multiple studies have shown that the Lachman test is the most sensitive and specific in the diagnosis of acute ACL tears, and generally superior to both the anterior drawer test and the pivot shift test.[1]
Which is better, Lachman's or pivot shift?
The anterior drawer test has a sensitivity of 48% and a specificity of 93%. The pivot shift test has a sensitivity of 61% and a specificity of 97% and has the highest positive predictive value of the 3 tests.[5] Results have suggested that the pivot shift test has a lower sensitivity than the Lachman test because it is generally a harder test to perform in the acute setting due to patient guarding. [9]
What is the function of the ACL?
The primary function of the ACL is to control anterior movement of the tibia and inhibit extreme ranges of tibial rotation. The ACL consists of 2 major bundles; the posterolateral bundle and the anteromedial bundle, which are named based on their tibial insertion. The bundles originate on the posteromedial side of the lateral femoral condyle and insert just anterior to the intercondylar tibial eminence. The Lachman test directly assesses the integrity of this anatomical relation. [2]
How to diagnose anterior cruciate ligament tear?
Diagnosis of an anterior cruciate ligament tear is definitively made by diagnostic imaging (MRI) or knee arthroscopy, but most often, the patient's history and physical presentation can reliably establish the diagnosis. Suggestive clinical findings of an ACL rupture include an acute knee effusion with positive Lachman, pivot shift, and/or anterior drawer tests. [4]
What is physical examination?
Physical examination includes inspection, palpation, testing of mobility, strength, and stability, and performance of special tests of ACL integrity. One should always examine the unaffected knee for comparison as patients have a baseline increased laxity with Lachman testing that is not due to injury. It is often best to examine the patient immediately after the injury or at least within several hours for a suspected ACL injury to avoid evaluating a knee with significant swelling and hemarthrosis, which may lead to patient guarding and negatively impact testing accuracy. [3][4]
How to stabilize a distal femur?
The patient is positioned supine with their injured knee flexed to 20 to 30 degrees while also slightly externally rotating the injured leg to relax the iliotibial band. The examiner then uses one hand to stabilize the distal femur while using the other hand to grasp the proximal tibia. Next, an anterior force is applied to the proximal tibia in an attempt to sublux the tibia forward while keeping the femur stabilized. [5]
Does a manual cruciate ligament test require instrumentation?
The manual test (30 degrees stress physical examination) does not require any instrumentation to diagnose an anterior cruciate ligament injury. Remember that the test can be subject to errors, depending on the strength of the operator and the patient's posture. A study showed through an arthrometer that the average force to be applied with the Lachman test is about 80 N (Newton).
What is the Lachman Test of the Knee?
The Lachman Test is commonly used in orthopedic examinations to test for anterior cruciate ligament (ACL) integrity. The test primarily targets the posterolateral bundle of the ligament. It tests one-plane anterior stability and is one of the most well known and most used special tests.
What does it mean when the ACL is soft?
A soft end feel / endpoint is indicative of secondary structures stopping the continued anterior translation of the tibia. Excessive anterior translation may also be noted. A hard/firm end feel will be felt when the ACL is intact and abruptly halts continued anterior translation.
How many degrees should a knee be flexed?
The knee to be tested should be flexed to about 20 degrees. One of the examiners hands holds and stabilizes the distal femur of the leg to be tested. The examiners other hand firmly grasps the proximal tibia of the same leg.
Is the Lachman test accurate?
The Lachman Test is quite accurate but should not be used as the only criterion for ruling in or out AC L integrity . Of the ACL integrity tests, it is widely considered to be the most sensitive.
How accurate is the Lachman test?
Katz and Fingeroth reported that the Lachman test has a diagnostic accuracy of acute ACL ruptures (within 2 weeks of examination) of 77.7% sensitivity and > 95% specificity. This study reported the diagnostic accuracy of subacute/chronic ACL ruptures (more than 2 weeks before examination) as having an 84.6% sensitivity and >95% specificity. It is important to note that in this study all examinations were performed under anesthesia, and therefore the diagnostic accuracy in physiotherapy clinical practice may be less.
How to perform a stable Lachman test?
The Stable Lachman test is recommended for examiners with small hands. The patient lies supine with the knee resting on the examiner’s knee. One of the examiner’s hands stabilizes the femur against the examiner’s thigh, and the other hand applies anterior stress. Adler and associates described a modification of this method, which they called the “drop leg Lachman test.” The patient lies supine. The test leg is abducted off the side of the examining table, and the knee is flexed to 25°. One of the examiner’s hands stabilizes the femur against the table while the patient’s foot is held between the examiner’s knees. The examiner’s other hand then is free to apply the anterior translation force. These researchers found that greater anterior laxity was demonstrated by this version of the test than by the classic version. The two legs are compared.
What test is used to diagnose ACL rupture?
Other special tests with the purpose of diagnosing ruptures of the ACL by testing its integrity include the knee anterior drawer test and the pivot shift test.
What is the purpose of the Lachman test?
The test is designed to assess single and sagittal plane instability.
Where should the examiner place his hand?
The examiner should place one hand behind the tibia and the other on the patient's thigh. It is important that the examiner's thumb be on the tibial tuberosity. On pulling the tibia anteriorly, an intact ACL should prevent forward translational movement of the tibia on the femur ("firm end-feel").
How to do a Bates physical exam?
Technique. Lie the patient supine on the bed. Place the patient's knee in about 20-30 degrees flexion. According to Bates' Guide to Physical Examination, the leg should also be externally rotated slightly. The examiner should place one hand behind the tibia and the other on the patient's thigh.
What to do if playback doesn't begin?
If playback doesn't begin shortly, try restarting your device.
What is the Lachman test?
Lachman Test (or Noulis Test) is used to assess the integrity of the anterior cruciate ligament (ACL) of the knee. It’s certain proof of anterior cruciate ligament insufficiency.
What does a positive Lachman Test mean?
The Lachman Test is positive if there is excessive anterior translation of the proximal tibia greater than the uninjured side and also a lack of a firm endpoint indicating an anterior cruciate ligament injury.
What does a hard end point mean in a cruciate ligament?
The motion must have a soft end point. Any hard end point suggests a certain stability of the anterior cruciate. Where this occurs within 3 mm , it suggests complete stability; where it only occurs after 5 mm , it suggests relative stability with previous elongation of the anterior cruciate.
What is the insufficiency of the anterior cruciate ligament?
Insufficiency of the anterior cruciate ligament is therefore particularly evident in this position of the joint as it approaches extension due to the occurrence of lateral subluxation of the proximal tibia (pivoting).
How to exclude posterior cruciate lesion?
Where the end point is hard, a posterior cruciate lesion must be excluded by testing the spontaneous posterior drawer and applying the active tests.
Which ligament is more or less taut?
First, all parts of the anterior cruciate ligament are more or less equally taut.
Which ligaments are involved in anterior tibial displacement?
Generalized anterior instability (involving the anterior cruciate ligament and the medial, posteromedial, lateral, and posterolateral capsular ligaments) will produce significant active anterior tibial displacement in internal and neutral rotation and, especially, in external rotation.
What is the second criteria for a Lachman test?
The second criteria to assess the Lachman test is the amount of laxity (movement) of the joint. The grading is based on a comparison to the non-injured extremity. Therefore, it is common for your doctor to examine both knees to determine the grade of the Lachman test.
What is a firm endpoint?
Typically an examiner will describe the endpoint as either "firm" or "soft." A firm endpoint implies the ACL is doing its job to limit the amount of movement in the knee joint. A soft endpoint is indicative of the ACL not functioning well and other structures (the secondary stabilizers) limiting the amount of movement in the joint.
What is the Lachman test?
The Lachman test is used to diagnose an anterior cruciate ligament (ACL) tear. The ACL is one of four major knee ligaments that contribute to the stability of the knee joint. An ACL tear often occurs as a sport-related injury and may require surgical reconstruction for treatment. Jan-Otto / Getty Images.
What is the KT 1000?
The KT-1000 has been shown to be a reliable measure that can more precisely measure the grade of the Lachman test. 2 .
Can a damaged ACL cause more movement?
Knees with a damaged ACL may demonstrate more movement and a less firm endpoint during a Lachman test.
Does Verywell Health use peer reviewed sources?
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Who is Jonathan Cluett?
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.
What is the Lachman Test?
The Lachman test is a physical examination test used by Doctors for the examination of knee joint mainly integrity of the anterior cruciate ligament if doctors have suspected that ACL injury. The test is mainly used to assess the anterior translation of the tibia in relation to the femur and is counted as a variation of the anterior drawer test.
Interpretation of this test
This test is considered to positive when do the excessive anterior translation of the proximal tibia greater than of the unaffected side & also of the lack of to the firm endpoint.
Comparison of the Lachman test with to the an anterior drawer test?
Anterior drawer test = it is commonly done at to the same time as to the Lachman test for to the help & confirm of to the diagnosis of an the ACL injury.
What is Lachman Test?
The Lachman test is used to check for an anterior cruciate ligament (ACL) tear or injury in the knee joint. It is considered the most sensitive and specific test for diagnosing acute ACL injuries.
What is a positive Lachman’s test?
A positive Lachman test indicates a torn ACL.
What is the knee flexed to in a Lachman test?
In Lachman test only the knee joint is involved as the knee is bent into 20 to 30 degrees of flexion. In anterior drawer test both the knee and hip joint are involved. As the hip is flexed to 45° and the knee is flexed to 90°. The examiner grasps the patient’s lower thigh (femur) with one hand to stabilize the femur.
What is a hard endpoint?
Hard Endpoint – An endpoint is hard when the ACL abruptly (suddenly) stops further forward movement (anterior translation) of the tibia on the femur. The examiner feels a hard or firm endpoint when the ACL is intact.
How many mm does the tibia move?
If the tibia moves more than 5 mm or more than the uninvolved side. Then this will give the examiner an indication that the patient has either sprained or torn the ACL ligament (positive anterior drawer test).
What is the function of the anterior cruciate ligament?
The main function of the ACL is to prevent the anterior translation of the tibia. There are generally two types of injuries common in an ACL tear. One is a contact type injury, and the other is a non-contact type injury.
Which is better, Lachman or anterior drawer?
Jonsson et al. concluded that in analyzing an acutely injured knee in an individual without anaesthesia, the Lachman test was superior to the anterior drawer test. However, in chronic conditions, both the evaluations had higher diagnostic accuracy.
How to perform a Lachman test?
To perform the Lachman test, the patient should be relaxed in the supine position. Passively place the patient’s knee into 20 to 30 degrees of knee flexion. The examiner will stabilize the patient’s distal femur on the leg to be tested.
What is the most sensitive test for ACL rupture?
Lachman Test. The Lachman Test is used to identify ACL tears and is considered the most sensitive test for ACL ruptures. The ACL or anterior cruciate ligament is one of four major ligaments of the knee and is a very common sports injury.
What does a positive tibia test mean?
A positive test occurs when the tibia translates forward beyond the resting position and more than 2 mm in comparison to the opposite knee. A positive test results in a ‘soft end feel’ as opposed to a ‘firm end feel’ in which the tibia does not translate forward.
What is the grade of ACL tear?
ACL tears are classified as grades 1 – 3 depending on the degree of translation.
Purpose
Technique
- Lie the patient supine on the bed. Place the patient's knee in about 20-30 degrees flexion. According to Bates' Guide to Physical Examination, the leg should also be externally rotated slightly. The examiner should place one hand behind the tibia and the other on the patient's thigh. It is important that the examiner's thumb be on the tibial tuberosity. On pulling the tibia anteriorly…
Technique Modification
- The Stable Lachman test is recommended for examiners with small hands. The patient lies supine with the knee resting on the examiner’s knee. One of the examiner’s hands stabilizes the femur against the examiner’s thigh, and the other hand applies anteriorstress.Adler and associates described a modification of this method, which they called the “drop leg Lachman test.” The pati…
Evidence
- Katz and Fingeroth reported that the Lachman test has a diagnostic accuracy of acute ACL ruptures (within 2 weeks of examination) of 77.7% sensitivity and >95% specificity. This study reported the diagnostic accuracy of subacute/chronic ACL ruptures (more than 2 weeks before examination) as having an 84.6% sensitivity and >95% specificity. It is important to note that in t…
Clinical Notes
- Frank reported that to achieve the best results, the tibia should be slightly laterally rotated and the anterior tibial translation force should be applied from the posteromedial aspect. The hand on the tibia should apply the translation force. With acute trauma, swelling prevents the examiner from getting a true indication of the joint’s mobility. The best time to assess joint laxity is immediatel…
How Do You Perform The Lachman’s Test?
- The examiner holds the patient’s knee between 15 and 30° of flexion.
- In this position in particular, the stabilizing function of the anterior cruciate ligament is essential in changing direction and braking.
- Insufficiency of the anterior cruciate ligament is therefore particularly evident in this position of the joint as it approaches extension due to the occurrence of lateral subluxation of the pro…
- The examiner holds the patient’s knee between 15 and 30° of flexion.
- In this position in particular, the stabilizing function of the anterior cruciate ligament is essential in changing direction and braking.
- Insufficiency of the anterior cruciate ligament is therefore particularly evident in this position of the joint as it approaches extension due to the occurrence of lateral subluxation of the proxim...
- The tibia should be slightly externally rotated and the anterior tibial translation force (anterior drawer) should be applied from the posteromedial aspect.
What Does A Positive Lachman Test Mean?
- The Lachman Test is positive if there is excessive anterior translation of the proximal tibia greater than the uninjured side and also a lack of a firm endpoint indicating an anterior cruciate ligament injury. The end point of motion must be soft and gradual without a hard stop; any hard stop suggests a degree of stability of the anterior cruciate ...
Lachman Test Modifications
- 1. Prone Lachman Test:
Prone Lachman Test is another special test for ACL injury. The patient is prone. The examiner grasps the lateral aspect of the proximal tibia and immobilizes the patient’s leg in his or her own axilla. With the other hand, the examiner grasps the distal femur immediately proximal to the pat… - 2. Stable Lachman Test:
The patient is supine. The examiner places the patient’s thigh over his or her ow n thigh. This holds the patient’s leg in constant flexion that the patient cannot change. With the distal hand, the examiner pulls the tibia anteriorly while the other hand immobilizes the patient’s thigh on the exa…
Notes
- A false-negative Lachman test may occur in these situations: 1. The femur is not properly stabilized. 2. Meniscus lesion or degenerative changes such as osteophytes on the intercondylar eminence block translation. 3. The tibia is medially rotated. 4. A significant hemarthrosis. 5. Protective hamstring spasm. 6. Tear of the posterior horn of the medial meniscus. In a concurre…
Accuracy
- The accuracy and reliability of the anterior cruciate ligament test appears to vary. Katz et al. found that in the hands of an experienced clinician, accuracy of this test was 1: 1. Sensitivity: 81.8 % 2. Specificity: 96.8 % The sensitivity and specificity of the Lachman test knee increases to 100% if the patient was anesthetized 2.
Reference
- Katz JW, Fingeroth RJ. The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee...
- DeHaven KE. Arthroscopy in the diagnosis and management of the anterior cruciate ligament deficient knee. Clin Orthop Relat Res. 1983 Jan-Feb;(172):52-6. PMID: 6822005.
- Katz JW, Fingeroth RJ. The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee...
- DeHaven KE. Arthroscopy in the diagnosis and management of the anterior cruciate ligament deficient knee. Clin Orthop Relat Res. 1983 Jan-Feb;(172):52-6. PMID: 6822005.
- Jonsson T, Althoff B, Peterson L, Renström P. Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparative study of the Lachman test and the anterior drawer sign. Am J Sports Med...
- Larson RL. Physical examination in the diagnosis of rotatory instability. Clin Orthop Relat Res. 1983 Jan-Feb;(172):38-44. PMID: 6822003.