Drawer test

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The front or rear drawer test ( engl. Drawer test ) is a test method in trauma surgery and orthopedics . The drawer test, together with the Lachman test, is used for the primary clinical diagnosis of a rupture of the anterior or posterior cruciate ligament ( cruciate ligament tear ) of the knee joint by examining the anterior (lying in front) and posterior (lying behind) translation ( parallel displacement)). In the dog, it can be supplemented by the tibial compression test .

Some recommend carrying out the drawer test only within the first 48 hours after the injury if an external ligament tear is suspected, in order not to risk that the ligaments will become loose again in the event of a ligament tear. If more than 48 hours have passed, one should assume a crack instead.

execution

Usually, the patient to be tested should keep the knee in a supine position in a 90 ° bent position. Letting the lower leg hang down , for example from the examination table, avoids most possible sources of error. The examiner then grips the bent knee with both hands so that the index fingers of both hands are in the hollow of the patient's knee. The lower leg is now pulled forward or pushed back. In the front drawer test, the lower leg is moved ventrally against the thigh and in the rear drawer test it is moved dorsally accordingly . The extent of the possible parallel displacement - in relation to the unaffected knee - is important for the assessment, together with the quality of the end point of the displacement.

Result

The respective drawer test is considered positive if the lower leg can be moved by more than 0.5 cm in the respective direction against the thigh. If the anterior drawer is positive, the anterior cruciate ligament is damaged ; if the posterior drawer is positive, the posterior one. Magnetic resonance imaging (“nuclear spin”) or arthroscopy is then often performed to confirm the diagnosis . With the latter, there is also the option of surgical therapy in the form of a partial cruciate ligament resection (in the event of a tear), a re-fixation of the torn ligament at its natural attachment point or a cruciate ligament plastic.

Sources of error

In the case of the drawer test, its exact execution is of great importance for the reliability of the diagnosis, since both anterior and posterior cruciate ligament rupture can mask each other, as the lower leg slips into an unnatural position in relation to the thigh (ACL tear: forward; PCL tear: to the rear), so that if the knee has slipped, then the rupture of the wrong cruciate ligament is diagnosed. The knee is then supposedly displaceable in the direction of the intact cruciate ligament. Therefore, the knee should always be brought into the "neutral position" before the test.

Compared to the Lachman test, the informative value of the drawer test is less.

Medical history

The origin of the drawer test is largely unclear. Paessler and Michel name Paul Ferdinand Segond , who in 1879 first described 'abnormal mobility of the knee' as a result of a torn cruciate ligament.

Web links

Individual evidence

  1. a b c M. Wolter: The follow-up treatment of anterior cruciate ligament surgery with and without an orthosis - a comparative study. (PDF; 961 kB) Dissertation, LMU Munich, 2009, p. 22.
  2. D. Kohn et al.: Diagnosis of the rupture of the anterior cruciate ligament. In: Orthopedist. 31, 2002, pp. 719-730. PMID 12426750
  3. Daniel Koch : The filled knee joint - what is it? In: Kleintiermedizin 4-2016, pp. 166–170.
  4. Karl Eberius: Torn ligament on the ankle (ankle, foot). In: www.medizinjournalist.com. Retrieved September 29, 2018 .
  5. a b M. Rüegsegger, RP Jakob: Diagnostics of recent and chronic knee joint injuries. In: Orthopedist. 22, 1993, pp. 343-350. PMID 8309692 (Review)
  6. SJ Kim, HK Kim: Reliability of the anterior drawer test, the pivot shift test and the Lachman test. In: Clin Orthop Relat Res 317, 1995, pp. 237-242. PMID
  7. B. Beynnon et al: The measurement of anterior cruciate ligament strain in vivo. In: Int Orthop. 16, 1992, pp. 1-12. PMID 1572761 .
  8. ^ HH Paessler, D. Michel: How new is the Lachman test? In: Am J Sports Med. 20, 1992, pp. 95-98. doi: 10.1177 / 036354659202000122 PMID 1554082
  9. GA Malanga et al .: Physical Examination of the Knee: A Review of the Original Test Description and Scientific Validity of Common Orthopedic Tests. In: Arch Phys Med Rehabil. 84, 2003, pp. 592-603. PMID 12690600 (Review)