Lachman Test

Aka: Lachman Test, Lachman's Test

1. Indications
   1. Assessment for Anterior Cruciate Ligament Rupture
2. See Also
   1. Knee Exam
   2. Knee Anterior Drawer Test
   3. Pivot Shift Test (MacIntosh Test)
3. Efficacy
   1. Lachman Test is most sensitive test for ACL rupture
   2. Likelihood Ratio
      1. Positive Test: 42 (very predictive)
      2. Negative Test: 0.1
   3. References
      1. Solomon (2001) JAMA 286:1618
4. Technique: Patient position
   1. Knee in 10 to 20 degrees flexion
5. Technique: Examiner position
   1. Non-dominant hand
      1. Stabilizes distal femur
   2. Standard Dominant hand positioning
      1. Grasps back of proximal tibia posteriorly
         1. Hold slightly below popliteal space
      2. Place Thumb over joint line anterolaterally
         1. Apply slightly above tibial plateau
         2. Increases sensitivity for joint laxity
   3. Alternate position for larger thigh (difficult to hold)
      1. Prop knee up in 10-20 degrees flexion
         1. Pillow in popliteal fossa
         2. Allow leg to over edge of table
      2. Technique
         1. Use both hands, apply fingers behind proximal tibia
         2. Apply thumbs to either side of tibial plateau
6. Technique: Test
   1. Pulling proximal tibia anteriorly and posteriorly
   2. Compare both sides for end-point laxity
7. Interpretation: Positive Test for ACL rupture
   1. Lax endpoints on anterior translation