Posterior Drawer Test (PCL)
- Fysiobasen
- Sep 15
- 2 min read
The Posterior Drawer Test is used to evaluate the integrity of the posterior cruciate ligament (PCL). A positive test indicates increased posterior translation of the tibia, suggesting PCL injury【1】【2】.
Execution Technique
Patient position:
The patient lies supine with the knee flexed to approximately 90°.
Test procedure:
The clinician sits on the patient’s foot to stabilize the leg.
Both hands are placed around the proximal tibia, just below the joint line, with the thumbs on the tibial tuberosity.
A posterior force is applied, pushing the tibia backward.
The clinician observes for posterior translation of the tibia relative to the femur.
Interpretation:
Positive test: Increased posterior movement (>6 mm) without a firm end point, indicating possible PCL rupture.
Negative test: Minimal posterior displacement with a firm end point.
Evidence and Diagnostic Value
Sensitivity: 90%
Specificity: 99%
Diagnostic accuracy: 96%【3】【6】
The test is most accurate for grade II and III PCL injuries. Use of the Posterior Sag Sign can further improve diagnostic accuracy【4】. Budoff and Nirschl emphasized that grading posterior laxity is crucial for guiding treatment decisions【5】.
Conclusion
The Posterior Drawer Test is the most reliable clinical test for evaluating PCL injuries. It should ideally be performed together with the Posterior Sag Sign to maximize diagnostic accuracy.
Sources:
Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination: fundamentals for the evidence-based clinician. United States; Evidence in motion: 2008.
Magee DJ. Orthopedic Physical Assessment: 5th Edition. St. Louis, MO: Saunders Elsevier; 2008.
Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination: fundamentals for the evidence-based clinician. United States; Evidence in Motion: 2008.
Malanga GA, Andrus S, Nadler SF, McLean J. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Arch Phys Med Rehabil. 2003;84:592-603.
Budoff JE, Nirschl RP. Knee problems: diagnostic tests for ligament injuries. Consultant. 1997;919-930.
The Accuracy of the Clinical Examination in the Setting of Posterior Cruciate Ligament Injuries. Rubinstein RA Jr., Shelbourne KD, McCarroll JR, et al: Am J Sports Med 22: 550-557, 1994 (level of evidence: A2)
