Lachman Test is a passive movement test to find the integrity of the anterior cruciate ligament (ACL). The test is designed to assess single and sagittal plane instability.
With the patient in supine, the patient's knee must be placed in about 20-30 degrees flexion with the leg in external rotation. The examiner should place one hand behind the tibia and the other on the patient's thigh. The examiner must place the thumb on the tibial tuberosity. When the tibia is pulled anteriorly, the ACL should prevent forward translational movement of the tibia on the femur ("firm end-feel").
Instead, if it gives a soft or a mushy end-feel, it will indicate a positive test. If the anterior translation as compared to the uninvolved knee is 2mm or more, it suggests a torn ACL ("soft end-feel"), as does 10mm of total anterior translation. An instrument called a "KT-1000" can be used to determine the magnitude of movement in millimeters.
a) Stable Lachman Test
b) Drop leg Lachman Test.
With acute trauma, swelling prevents the examiner from getting a true indication of the joint’s mobility. The best time to assess joint laxity is immediately after the injury, before swelling occurs, or in the chronic state. The examiner may need to allow time for swelling to reduce before true joint mobility can be assessed.
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