• Assess the integrity of the posterior cruciate ligament (PCL)

• The PCL is attached to the posterior intercondylar area of the tibia and passes anteriorly, medially, and upward to attach to the lateral side of the medial femoral condyle.
• This ligament prevents backward displacement of the tibia or forward sliding of the femur.

1. The patient should be lying supine on the exam table
2. Have the patient flex the hip and knees to 90°, feet should be flat on the table (the examiner may sit on the patients foot to ensure it stays flat).  Note: Palpate the hamstring to confirm complete relaxation
3. On the involved side, place your hands along the sides of the knee, palpate the joint line
4. Apply an anterior-to-posterior directed force through the proximal tibia
5. Note the degree of backward movement in the femur
   
6. Repeat the test on the non-involved side and compare results

• Negative: noticeable end-feel and minimal movement
• Positive: absence of an end-feel and the proximal tibia falls back (excessive translation).  The amount of posterior movement determines the grade of PCL tear.
• Grade 1 = 0 - 5 mm
• Grade 2 = 6 - 10 mm
• Grade 3 = 11+ mm

• Based on a Prospective, randomized, blinded, controlled study of 39 patients (19 with known PCL tears, 9 with ACL tears, and 12 normal controls). Orthopedic surgeons with fellowship training were able to determine PCL tears with 96% accuracy.  (Rubinstein RA, 1994).
• Sensitivity: 90%
• Specificity:  99%
• Likelihood ratio:
• Positive test: LR: 90
• Negative test: LR: 0.1

• Isolated PCL tears are less common and usually result from a direct blow to the proximal tibia
• Assessing for the presence of the posterior sag sign enhances the tests diagnostic accuracy

• Anatomy: Knee - General Review
• Physical Exam:  Anterior Drawer Test
  

1. Bickley LS et al. Bates' Guide to Physical Examination and History Taking. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2013;658.
2. Malanga GA et al. 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.
3. Marieb EN, Hoehn K. Anatomy & Physiology. 3^rd ed. San Fransisco, CA: Pearson Benjamin Cummings. 2008;237.
4. Rubinstein RA, Jr. et al. "The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries." The American journal of sports medicine. Jul-Aug 1994; 22(4):550-557.

Editors:

• Anthony J. Busti, MD, PharmD, FNLA, FAHA
  

Last Reviewed: July 2015