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Lachman Test: Knee Diagnosis Explained

The Lachman Test is a clinical examination method used to diagnose anterior cruciate ligament (ACL) injuries of the knee joint.

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Things worth knowing about "Lachman Test"

The Lachman Test is a clinical examination method used to diagnose anterior cruciate ligament (ACL) injuries of the knee joint.

What is the Lachman Test?

The Lachman Test is a clinical examination technique widely used in orthopedics and sports medicine to assess the stability of the anterior cruciate ligament (ACL) in the knee joint. It is considered one of the most reliable and frequently used tests for diagnosing an ACL tear. Named after the American orthopedic surgeon John Lachman, it has been a standard part of orthopedic diagnosis since the 1970s.

How the Lachman Test is Performed

During the Lachman Test, the patient lies in a supine position (on their back). The knee being examined is held at a flexion angle of approximately 20 to 30 degrees. The examiner stabilizes the thigh with one hand while grasping the lower leg from behind with the other hand. The lower leg is then drawn forward relative to the thigh.

Normal finding (negative): The ACL is intact; the lower leg can only be minimally displaced forward, and a firm, clear end point is felt.
Positive finding: If the ACL is torn, the lower leg slides noticeably forward, and the end point is soft or absent. This is referred to as a positive Lachman Test.

Clinical Relevance and Indications

The Lachman Test is indicated when an ACL injury is suspected, for example following sports accidents, falls, or rotational trauma to the knee. Typical symptoms that prompt this examination include:

Sudden knee pain following trauma
A feeling of instability or the knee "giving way"
Swelling of the knee joint (hemarthrosis)
Restricted range of motion

Compared to the older anterior drawer test (performed at 90 degrees of knee flexion), the Lachman Test offers the advantage of being more effective and informative in acute injuries with pain and swelling, as well as in patients with strong musculature.

Sensitivity and Specificity

The Lachman Test is regarded as the most sensitive clinical test for diagnosing an ACL rupture. Studies report sensitivity values of up to 85–98% and specificity of approximately 90–99%, making it one of the most precise manual examination techniques for the knee. Nevertheless, it does not replace imaging diagnostics.

Further Diagnostic Workup

A positive Lachman Test or an inconclusive finding typically leads to additional diagnostic investigations:

MRI (Magnetic Resonance Imaging): The gold standard for visualizing ACL tears and associated injuries (e.g., meniscal lesions, bone contusions)
X-ray: To rule out bony injuries
Pivot-Shift Test: A complementary clinical test to assess rotational instability
Anterior Drawer Test: An additional clinical test performed at 90 degrees of knee flexion

Treatment Options Following a Positive Finding

A confirmed ACL rupture can be treated either conservatively or surgically, depending on the patient's age, activity level, and associated injuries:

Conservative treatment: Physiotherapy, muscle strengthening, and stabilization exercises – suitable for less active patients or partial tears
Surgical treatment (ACL reconstruction): Arthroscopic procedure using a tendon graft (e.g., patellar tendon or hamstring tendons) – recommended for physically active patients or cases of combined instability

References

Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2006;36(5):267–288.
Magee DJ. Orthopedic Physical Assessment. 6th ed. Saunders Elsevier; 2014.
Scholten RJ, Opstelten W, van der Plas CG, et al. Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis. Journal of Family Practice. 2003;52(9):689–694.

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