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The Lachman test is a specific clinical exam technique used to evaluate patients with a suspected anterior cruciate ligament (ACL) injury. The test relies on proper positioning and technique and is regarded as the most sensitive and specific test for diagnosing acute ACL injuries. This article also describes the proper interpretation of Lachman test clinical exam findings, allowing clinicians to more effectively diagnose ACL injuries in the acute or outpatient setting. This activity describes the Lachman test and highlights the role of the clinician and the interprofessional healthcare team in evaluating patients with a suspected ACL injury. Objectives: Outline the indications for performing a Lachman test. Describe the technique of the Lachman test in a patient with a suspected anterior cruciate ligament (ACL) injury. Review the clinical significance of the Lachman test. Explain the interprofessional team strategies for the prompt evaluation of patients with suspected anterior cruciate ligament (ACL) injuries to expedite diagnosis and management. Access free multiple choice questions on this topic.

The Lachman test is a physical examination maneuver used to assess the integrity of the anterior cruciate ligament in a suspected anterior cruciate ligament (ACL) injury. The test is used to evaluate the anterior translation of the tibia in relation to the femur and is considered a variant of the anterior drawer test. Multiple studies have shown that the Lachman test is the most sensitive and specific in the diagnosis of acute ACL tears, and generally superior to both the anterior drawer test and the pivot shift test.[1]

The Lachman test is widely regarded as the most useful test for diagnosing an acute ACL injury and should be used in conjunction with the pivot shift test and anterior drawer test for assessing ACL integrity. Prompt evaluation and diagnosis of ACL injuries by the interprofessional healthcare team are essential to expedite further management and rehabilitation. The team consists of primary care and emergency providers, sports medicine physician, orthopedists, and nurses. It is important to evaluate and consider other knee structures that often sustain an injury in conjunction with an ACL injury, as isolated ACL tears reportedly occur less than 10% of the time in acute knee injuries.[15] A clinician should also examine and test for medial and lateral collateral ligament, posterior cruciate ligament, and meniscal injuries in conjunction with the Lachman test for a suspected ACL injury. Appropriate positioning, technique, and interpretation of the Lachman test are essential for correctly diagnosing an ACL injury. If an ACL injury is detected, the patient is usually referred to an orthopedist. Orthopedic nurses assist in coordinating care, provide patient and family education, and communicate status to the orthopedist. [Level 5]

A study reports that conducting the test in a multidisciplinary context could be detrimental to the accuracy of the test.[16] Probably, to take the test correctly, the doctor or the operator would have to do a manual training procedure (as for other manual tests).[17] The test's accuracy is best under anesthesia.[18]