Posterior Drawer Test, PCL Injury - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the Posterior Drawer.

The Posterior drawer test is the most accurate test for PCL injury. The posterior cruciate ligament is located in the back of the knee. The PCL is the primary restraint to the posterior tibial translation. Injuries to the PCL are not as common as other ACL injuries. Injuries to the PCL can be missed.
When do you do the test?
•As a part of the routine exam of the injured knee
•If you suspect a tear of the PCL
•If you find laxity anteriorly and posteriorly while evaluating for ACL tear with the Lachman’s test.
Check to make sure that it is not PCL injury. The PCL tear may give a false Lachman’s test due to posterior subluxation.
Test is done with the patient in supine position and the knee is flexed to 90 degrees. The examiner stabilizes the foot. Next the examiner pushes backwards on the tibia, looking for the tibia to sag posteriorly. Observe the sag that develops due to tear of the posterior cruciate ligament. The amount of translation in relationship to the femur is observed. The test is considered positive if excessive posterior translation of the tibia is demonstrated. Move the thumb from the femoral condyle to the tibial plateau. The medial tibial plateau is normally 10 mm anterior to the media femoral condyle. If the PCL is intact, a step-off between the medial femoral condyle and medial tibial plateau is maintained when posterior force is applied to the proximal tibia.
Posterior Sag test
Both knees are flexed to 90 degrees and the knee is viewed from the side to compare the positions of the anterior tibia.
The patient’s knee is flexed to 90 degrees and the patient is then asked to actively contract the quadriceps muscle with the leg stabilized. The tibia is seen being actively reduced from the posterior subluxed position.
Dial test is performed with the patient in the supine or prone position with both knees in 30 degree and 90 degree flexion. An external rotational force is then applied to both feet. The amount of external rotation to both lower extremity is measured at both ankles. Flexion at the 90 degree angle will test the posterior cruciate ligament for injury. Testing of the injured extremity in 30 degree of flexion is done to determine injury to the posterolateral corner. More than 10 degree of external rotation asymmetry at 30 degree and 90 degree is consistent with PLC and PCL injury. More than 10 degree of external rotation indicates a significant injury.
Mechanism of injury: A common cause of injury to the PCL is due to a bent knee hitting a dashboard during a car accident. Direct blow to the proximal tibia with the knee flexed. PCL injury may also occur due to non-contact hyperflexion of the knee with the foot in plantar flexion.
Knee extended, valgus or hyperextension injury = ACL injury
Knee bent, foot plantar flexed = PCL injury.
Rehab: ACL: hamstrings, PCL: quadriceps.

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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step