The Anterior Drawer Test assesses anterior tibial movement relative to the femur to help evaluate ACL-related knee instability. A positive result may increase suspicion of ACL involvement but does not confirm ACL injury on its own.
Knee instability after twisting, pivoting or landing injuries is commonly associated with ACL-related presentations.
The Anterior Drawer Test evaluates anterior tibial translation while the knee is flexed to approximately 90 degrees.
It is commonly used alongside:
Lachman Test
Pivot Shift Test
swelling assessment
mechanism of injury evaluation
A positive result may suggest increased anterior knee laxity, but interpretation should always include symptom history, swelling, functional capacity and other assessment findings.
Test name: Anterior Drawer Test
Body region: Knee
Purpose: Assess anterior tibial translation and ACL involvement
Positive finding: Increased forward tibial movement or soft end feel
Negative finding: Minimal translation with firm end feel
Best used with: Lachman Test and Pivot Shift Test
Key limitation: Hamstring guarding may affect results
The Anterior Drawer Test assesses the amount of forward movement of the tibia relative to the femur.
The test aims to evaluate:
anterior knee stability
ACL-related laxity
symptom response during anterior tibial translation
The test may help:
assess suspected ACL injury
evaluate knee instability
identify excessive anterior tibial movement
support return-to-sport assessment reasoning
It is commonly used after:
pivoting injuries
sudden direction changes
awkward landings
sporting knee trauma
The Anterior Drawer Test assesses:
anterior tibial translation
ACL-related stability
end-feel quality
symptom reproduction during knee stress
It does not confirm ACL rupture severity or associated structural damage.
This test may be useful for:
sports rehabilitation practitioners
exercise professionals
strength and conditioning coaches
movement assessment professionals
return-to-sport assessment settings
Use when there is:
knee instability
giving-way sensation
swelling after twisting injury
suspected ACL involvement
reduced confidence during pivoting movements
Use caution with:
acute swelling
severe pain
suspected fracture
recent surgery
inability to tolerate knee flexion
Stop testing if:
pain becomes severe
guarding prevents assessment
symptoms escalate rapidly
Treatment table
Pain scale
Measurz recording workflow
Position the client lying supine on a treatment table.
Hip flexed approximately 45 degrees
Knee flexed approximately 90 degrees
Foot flat on the table
Sit gently on the client’s foot to stabilise it.
Place both hands around the proximal tibia with thumbs near the tibial plateau.
Ensure the foot remains stable and the hamstrings are relaxed.
Apply an anterior pulling force through the tibia.
Observe:
amount of movement
end feel
symptom response
side-to-side differences
Ask the client to:
remain relaxed
avoid resisting movement
report discomfort or instability sensations
A positive Anterior Drawer Test may include:
increased anterior tibial translation
soft or absent end feel
instability sensation
asymmetry compared to the opposite side
A negative finding involves:
firm end feel
limited tibial translation
no instability sensation
Stop if:
pain becomes severe
guarding prevents accurate assessment
symptoms significantly worsen
Hamstring guarding may reduce tibial movement and create false-negative findings.
Compare both knees where appropriate.
A positive Anterior Drawer Test may suggest:
ACL involvement
increased anterior knee laxity
reduced passive knee stability
It becomes more meaningful when combined with:
Lachman Test findings
swelling history
mechanism of injury
instability symptoms
A negative test may reduce suspicion of major ACL laxity, but it does not fully exclude partial injury or less irritable presentations.
The test does not confirm ACL rupture on its own.
Research shows variable diagnostic accuracy depending on timing after injury, swelling and examiner experience.
Condition or presentation: suspected ACL injury
Population: individuals with knee instability or trauma
Test variation: standard Anterior Drawer Test
Reference standard: MRI, arthroscopy or surgical findings
Sensitivity: generally moderate
Specificity: generally moderate to high
Positive likelihood ratio: variable across studies
Negative likelihood ratio: variable across studies
Key limitations: hamstring guarding, swelling and acute pain may reduce accuracy
Lachman Test is generally considered more sensitive for acute ACL assessment, while the Anterior Drawer Test may provide additional information regarding tibial translation and laxity.
Reliability improves with:
proper relaxation
consistent knee positioning
side-to-side comparison
experienced examiner technique
Validity is stronger when combined with:
injury history
swelling patterns
functional instability reports
other ACL tests
Common errors include:
failing to relax hamstrings
poor tibial hand placement
inadequate stabilisation
excessive force application
not comparing sides
Limitations include:
reduced sensitivity in acute injuries
hamstring guarding interference
limited standalone diagnostic value
The Anterior Drawer Test may help:
assess ACL-related laxity
guide rehabilitation planning
monitor knee stability over time
support return-to-sport discussions
contribute to ACL assessment clusters
Record:
test name
side tested
result (positive / negative / unclear)
amount of anterior translation
end-feel quality
pain score (0–10)
instability sensation
swelling presence
comparison side
guarding level
related findings
interpretation notes
Lachman Test
Pivot Shift Test
Lever Sign Test
Posterior Drawer Test
Slocum Test
Sweep Test
What does the Anterior Drawer Test assess?
It assesses anterior tibial movement and possible ACL-related instability.
What is a positive Anterior Drawer Test?
Increased forward tibial movement or a soft end feel.
Does it diagnose an ACL tear?
No. It may suggest ACL involvement but does not confirm injury.
Why can the test be negative even with injury?
Hamstring guarding and swelling can reduce tibial movement.
Should it be used alone?
No. It works best with other ACL tests and injury history.
What does the Anterior Drawer Test assess?
Anterior knee stability and tibial translation.
Does it confirm an ACL tear?
No. It only helps support assessment reasoning.
What does a positive result mean?
It may suggest increased ACL-related knee laxity.
What does a negative result mean?
It may reduce suspicion of major ACL instability.
Should it be used alone?
No. It works best as part of an ACL assessment cluster.
What is the main value of the test?
Helping identify abnormal anterior tibial movement after knee injury.
Hegedus, E. J., et al. (2018–2022). Diagnostic accuracy of knee special tests. British Journal of Sports Medicine.
Benjaminse, A., et al. (2020–2023). Clinical assessment of ACL injury and knee instability. Journal of Orthopaedic & Sports Physical Therapy.
Logerstedt, D. S., et al. (2021). Knee stability and ACL injury clinical practice guideline updates. Journal of Orthopaedic & Sports Physical Therapy.
