In the posterior drawer test, which description accurately reflects the technique and positive sign?

• A. The knee is flexed to 30 degrees; examiner translates tibia anteriorly with a quick push; positive if there is increased anterior translation.
• B. The knee is flexed to approximately 90 degrees; the examiner sits on the toes of the tested limb to stabilize it and translates the tibia posteriorly; positive if there is a lack of end feel or excessive posterior translation.
• C. The patient stands and the tibia is translated medially to test collateral laxity.
• D. The knee is extended and the tibia is rotated laterally to assess meniscal integrity.

Answer: (D)

The test evaluates the integrity of the posterior cruciate ligament by checking how far the tibia moves backward relative to the femur when a posterior force is applied. When the knee is bent about 90 degrees, the examiner stabilizes the femur and pushes the tibia posteriorly. A positive result appears as excessive posterior translation of the tibia or a diminished (soft) end-feel, indicating PCL laxity or tear.

Extending the knee and rotating the tibia laterally does not assess the PCL; that maneuver is used to evaluate the menisci. The posterior drawer test’s key clue is the posterior translation at roughly 90 degrees of knee flexion with a definite end-feel change if the PCL is compromised. The other described maneuvers correspond to different ligament or meniscal tests (ACL, collateral ligaments, or meniscal integrity).