The Posterior Drawer Test assesses posterior tibial translation with the knee flexed, most commonly in relation to posterior cruciate ligament function. A positive result may increase suspicion of PCL-related posterior knee laxity, especially when it matches the client’s history and other findings, but it does not confirm a PCL injury on its own.
Posterior cruciate ligament injuries are less common than ACL injuries, but they can affect knee stability, confidence and function.
They may occur with:
dashboard-type trauma
a fall onto a bent knee
contact sport trauma
hyperflexion injury
multi-ligament knee injury
recurrent posterior knee instability
The Posterior Drawer Test is one of the most commonly used clinical tests for assessing posterior tibial translation and possible PCL-related laxity.
It is commonly used alongside:
Posterior Sag Sign
Quadriceps Active Test
Dial Test
knee swelling assessment
range of motion testing
gait and functional assessment
mechanism-of-injury history
imaging where clinically appropriate
Clinical sources and reviews describe the Posterior Drawer Test as an important physical examination test for suspected PCL injury, but diagnosis is usually made by combining history, physical examination, mechanical testing, imaging and professional judgement rather than one test alone.
Test name: Posterior Drawer Test
Body region: Knee
Purpose: Assess posterior tibial translation
Commonly associated presentation: Posterior cruciate ligament injury or posterior knee laxity
Positive finding: Increased posterior tibial translation or soft endpoint compared with the other side
Negative finding: Firm endpoint with no meaningful side-to-side posterior translation difference
Best used with: Posterior Sag Sign, Quadriceps Active Test, Dial Test, swelling assessment and mechanism-of-injury history
Key limitation: Grade 1 or partial injuries may be harder to identify; results should be interpreted with other findings
The Posterior Drawer Test is a knee orthopaedic test used to assess posterior translation of the tibia relative to the femur.
It is most commonly associated with the posterior cruciate ligament, which helps resist posterior movement of the tibia.
The test is performed with the:
client lying supine
hip flexed
knee flexed to approximately 90 degrees
foot stabilised
examiner applying a posterior force to the proximal tibia
The examiner observes and feels for:
posterior tibial translation
side-to-side difference
endpoint quality
pain response
guarding
posterior sag before testing
The Posterior Drawer Test may help support assessment reasoning when PCL injury or posterior knee laxity is suspected.
It may help professionals:
assess posterior tibial translation
compare the symptomatic and non-symptomatic knee
identify posterior laxity
grade the amount of posterior movement
document pain, guarding or instability response
guide further assessment selection
support referral or imaging discussion where appropriate
The test should not be used as a stand-alone diagnosis.
The Posterior Drawer Test assesses posterior tibial translation at the knee.
It may provide information about:
PCL-related posterior laxity
posterior knee instability
endpoint quality
side-to-side difference
symptom response during posterior loading
possible multi-ligament involvement when findings are large or complex
It does not directly identify:
exact PCL tear grade
partial versus complete tear with certainty
associated posterolateral corner injury
meniscal injury
cartilage injury
bone bruising
readiness to return to sport
This test may be useful for:
rehabilitation professionals
exercise professionals working within scope
strength and conditioning coaches working with allied health teams
performance coaches
movement assessment professionals
students learning knee special tests
professionals using Measurz or MAT for structured assessment recording
It may be relevant for clients who report:
trauma to the front of the shin
fall onto a bent knee
posterior knee instability
difficulty decelerating
instability on stairs or slopes
giving-way sensations
swelling after knee trauma
previous PCL injury or reconstruction
Use the Posterior Drawer Test when the history suggests possible PCL-related posterior knee laxity and the client can tolerate controlled testing.
It may be useful when the client reports:
dashboard-type injury mechanism
fall onto the front of the tibia
hyperflexion injury
posterior knee pain after trauma
instability during deceleration
difficulty with downhill walking
giving way during sport or daily activity
The test is more meaningful when posterior translation is clearly different from the other knee.
Use caution with:
acute painful knee trauma
large swelling or suspected haemarthrosis
suspected fracture
suspected multi-ligament injury
recent knee surgery
severe pain
high irritability
strong guarding
limited knee flexion
suspected neurovascular injury
Stop testing if:
pain escalates
the client feels unsafe
guarding prevents accurate testing
symptoms worsen significantly
the client asks to stop
there are red flags requiring medical review
Treatment table or plinth
Pain scale
Symptom and confidence recording
Measurz recording workflow
Optional comparison-side notes
Optional referral or further assessment notes where appropriate
Position the client lying supine.
Explain the test clearly before starting.
The client should understand that the test assesses controlled posterior movement of the tibia and that testing will stop if symptoms become unsafe or uncomfortable.
Client lies on their back
Hip is flexed to approximately 45 degrees
Knee is flexed to approximately 90 degrees
Foot is flat on the table
Hamstrings should be relaxed
Compare both knees where appropriate
Sit lightly on the client’s foot or stabilise it securely
Face the client’s knee
Place both hands around the proximal tibia
Keep thumbs near the tibial tuberosity or joint line for reference
Observe the resting position of the tibia before applying force
Both hands contact the proximal tibia
Fingers wrap around the back of the upper calf
Thumbs rest near the anterior tibia or joint line
Avoid pressing into painful soft tissue unnecessarily
Stabilise the foot so it does not slide.
Monitor for:
hamstring contraction
quadriceps guarding
hip rotation
foot movement
pelvic movement
pain or apprehension
The hamstrings should stay relaxed because hamstring contraction can reduce posterior translation and affect the result.
Apply a controlled posterior force to the proximal tibia.
The force should be:
straight posterior
firm but not aggressive
slow enough to feel endpoint quality
compared with the opposite side
Assess:
amount of posterior translation
endpoint firmness
side-to-side difference
symptom response
guarding
Ask the client to:
relax the thigh muscles
keep the foot relaxed
report pain or instability
describe whether the sensation is familiar
tell you if they want the test stopped
Example instruction:
“I’m going to gently push your shin backwards to assess knee stability. Stay as relaxed as possible and tell me if you feel pain, instability or apprehension.”
A positive Posterior Drawer Test may include:
increased posterior tibial translation compared with the other side
soft or absent endpoint
posterior sag before testing
familiar posterior instability
pain or apprehension with posterior loading
large side-to-side difference
Posterior translation is often graded by comparing the tibial position to the femoral condyles and the opposite knee.
A negative finding involves:
firm endpoint
no meaningful increase in posterior translation
no clear side-to-side difference
no familiar instability response
no posterior sag at rest
Stop if:
pain increases sharply
the client becomes highly apprehensive
guarding prevents accurate testing
the knee cannot be positioned safely
symptoms feel unsafe
the client asks to stop
Do not force the tibia aggressively
Check for posterior sag before testing
Compare both sides where possible
Record whether pain, laxity or instability was the main response
Use caution in suspected multi-ligament injury
A positive Posterior Drawer Test may increase suspicion of PCL-related posterior knee laxity when posterior tibial translation is greater than the comparison side.
A positive result is more meaningful when it matches:
dashboard-type trauma
fall onto a flexed knee
posterior sag sign
quadriceps active test findings
giving-way symptoms
posterior knee instability
relevant imaging findings where available
A positive result does not confirm a PCL tear on its own.
Other factors may influence the result, including:
hamstring guarding
pain
swelling
examiner force
generalised joint laxity
previous knee injury
posterolateral corner involvement
multi-ligament injury
incorrect starting position due to posterior sag
A negative test may reduce suspicion when:
the test is performed well
the client is relaxed
there is no posterior sag
no side-to-side difference is present
the history is not suggestive of PCL injury
However, a negative result does not fully exclude PCL injury, especially with:
partial injury
grade 1 laxity
acute pain or swelling
guarding
poor relaxation
complex multi-structure injury
Interpretation is stronger when combined with mechanism of injury, swelling, posterior sag, quadriceps active test, dial test and imaging where clinically appropriate.
The Posterior Drawer Test is generally considered one of the stronger clinical tests for PCL injury, particularly for higher-grade posterior laxity.
A commonly cited blinded clinical examination study reported high diagnostic accuracy for detecting PCL tear, with approximately:
Sensitivity: 90%
Specificity: 99%
Accuracy: 96%
The same clinical summaries note that examination accuracy may be higher for grade 2 and grade 3 posterior laxity than for grade 1 laxity.
A JOSPT systematic review on physical examination tests for PCL injury emphasised that diagnosis is generally made by combining:
history
physical examination
mechanical testing
imaging
arthroscopy where relevant
rather than relying on one clinical test alone.
Practical interpretation:
Higher sensitivity may make a negative result more useful for decreasing suspicion, but it does not exclude PCL injury on its own.
Higher specificity may make a positive result more useful for increasing suspicion, but it does not confirm PCL injury on its own.
Grade 1 or partial injuries may be harder to detect.
Accuracy depends on examiner skill, client relaxation, injury chronicity and the reference standard used.
The result should be combined with history, posterior sag, quadriceps active test, dial test and imaging where appropriate.
Reliability improves when the test is performed with consistent:
hip position
knee flexion angle
foot stabilisation
hand placement
posterior force direction
comparison-side testing
endpoint judgement
grading method
Reliability may be reduced by:
hamstring contraction
pain
swelling
guarding
examiner inexperience
inconsistent posterior force
failure to recognise posterior sag
generalised laxity
Validity is stronger when the result matches:
relevant injury mechanism
posterior sag sign
quadriceps active test
functional instability
side-to-side difference
imaging findings where clinically appropriate
Stress radiography in the posterior drawer position can quantify posterior tibial translation. A 2022 study found that 90-degree posterior drawer stress radiographs had sensitivity of 90.5% and specificity of 94.7% at a 10 mm cut-off for symptomatic PCL insufficiency. This supports the importance of posterior tibial translation measurement, but those values apply to stress radiography rather than the manual clinical test.
Common errors include:
missing posterior sag before testing
starting with the tibia already posteriorly displaced
allowing hamstring contraction
not stabilising the foot
applying force too quickly
applying force in the wrong direction
not comparing both sides
interpreting pain alone as positive
not assessing endpoint quality
using the test as a stand-alone diagnosis
Limitations include:
grade 1 laxity may be difficult to detect
acute pain and swelling can reduce accuracy
hamstring guarding can mask posterior translation
examiner experience affects interpretation
multi-ligament injuries can complicate findings
side-to-side comparison may be difficult if both knees are abnormal
The Posterior Drawer Test may help professionals:
assess posterior knee laxity
support PCL-related assessment reasoning
compare involved and uninvolved knees
document baseline instability response
monitor change over time
guide referral or imaging discussion
support communication with allied health or sports medicine teams
For athletes, it may contribute to broader return-to-training reasoning when combined with:
strength testing
deceleration assessment
landing assessment
change-of-direction testing
confidence measures
sport-specific movement testing
For general population clients, it may help explain symptoms during:
stairs
slopes
kneeling
deceleration
getting up from low positions
For Measurz users, the main value is consistent recording of side, posterior translation, endpoint quality, pain, instability response and related findings.
Record:
test name: Posterior Drawer Test
side tested: left, right or both
result: positive, negative, unclear or unable to test
grade if used: grade 0, 1, 2 or 3
client position
hip and knee angle
foot stabilisation method
force direction: posterior tibial translation
amount of posterior translation if estimated
endpoint quality: firm, soft or absent
posterior sag present or absent
pain score from 0–10
symptom location
symptom quality
whether symptoms were familiar
guarding or hamstring contraction
comparison side
irritability level
reason for stopping if stopped early
related findings, such as posterior sag, quadriceps active test, dial test or swelling
interpretation notes
planned retest date if monitoring change
Record whether the main response was:
increased posterior translation
soft endpoint
posterior sag
familiar instability
pain only
guarding
unclear response
unable to test safely
This improves:
repeatability
communication
client education
assessment reasoning
team consistency
progress monitoring
reporting quality
Posterior Sag Sign
Quadriceps Active Test
Dial Test
Lachman Test
Anterior Drawer Test
Pivot Shift Test
Sweep Test
Knee Range of Motion Tests
It assesses posterior tibial translation, most commonly in relation to posterior cruciate ligament function.
A positive result may include increased posterior tibial translation, a soft endpoint or clear side-to-side difference compared with the other knee.
No. It may increase suspicion of PCL-related posterior laxity, but it does not confirm a PCL injury on its own.
No. A negative result does not fully exclude PCL injury, especially with partial injury, low-grade laxity, pain, swelling or guarding.
Posterior sag can show that the tibia is already sitting posteriorly. If this is missed, the examiner may underestimate or misinterpret posterior drawer movement.
Commonly cited evidence reports sensitivity around 90%, specificity around 99% and accuracy around 96% for PCL tear detection, but accuracy may be lower for grade 1 laxity and depends on study methods and examiner skill.
It is best used with history, posterior sag sign, quadriceps active test, dial test, swelling assessment, functional testing and imaging where appropriate.
The Posterior Drawer Test assesses posterior tibial translation.
It is most commonly used in PCL-related knee assessment.
A positive result may include increased posterior translation or a soft endpoint.
A positive test may increase suspicion of PCL-related laxity but does not confirm injury on its own.
A negative test does not fully exclude PCL injury.
Grade 1 or partial injuries may be harder to detect.
Interpretation is stronger when combined with history, posterior sag, quadriceps active test, dial test, functional assessment and imaging where relevant.
Measurz should record side, result, grade, endpoint quality, posterior sag, pain, guarding, comparison side and related findings.
American Academy of Orthopaedic Surgeons. (2022). Management of anterior cruciate ligament injuries: Evidence-based clinical practice guideline. https://www.aaos.org/aclcpg
Jung, T. M., Reinhardt, C., Scheffler, S. U., & Weiler, A. (2022). Stress radiographs in the posterior drawer position at 90° flexion should be part of the diagnostic algorithm for chronic PCL insufficiency. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 835–843. https://pmc.ncbi.nlm.nih.gov/articles/PMC8880224/
Kopf, S., Beaufils, P., Hirschmann, M. T., Rotigliano, N., Ollivier, M., Pereira, H., Verdonk, R., Darabos, N., Ntagiopoulos, P., & Dejour, D. (2020). Management of traumatic posterior cruciate ligament injuries: The 2018 ESSKA PCL consensus. Knee Surgery, Sports Traumatology, Arthroscopy, 28, 1230–1242. https://doi.org/10.1007/s00167-020-05884-x
Schulz, M. S., Russe, K., Weiler, A., Eichhorn, H. J., & Strobel, M. J. (2003). Epidemiology of posterior cruciate ligament injuries. Archives of Orthopaedic and Trauma Surgery, 123, 186–191. https://doi.org/10.1007/s00402-002-0471-y
