What is the most accurate physical exam maneuver for diagnosing a PCL injury?

The posterior drawer test is the most accurate physical examination maneuver for diagnosing a posterior cruciate ligament (PCL) injury. This test directly assesses the integrity of the PCL by evaluating the posterior displacement of the tibia relative to the femur.

In a clinical setting, when performing the posterior drawer test, the examiner stabilizes the femur and applies posterior force to the tibia. If the PCL is injured, the tibia will move excessively posteriorly compared to the femur, indicating an instability associated with PCL damage. This method provides a clear and specific assessment of PCL function, making it a reliable maneuver for diagnosing PCL injuries.

Other tests, such as the anterior drawer test, are more focused on the anterior cruciate ligament (ACL) and do not effectively evaluate the PCL's condition. The Lachman test also targets ACL stability, while the pivot shift test is designed to assess both ACL integrity and knee stability during rotational movements. Therefore, the posterior drawer test stands out as the most precise physical exam maneuver for identifying PCL injuries.