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Home› Physical Therapy› Free Self-Checks› Special Tests› Knee

Knee Special Tests

Ligament and meniscus tests: how to do them, what a positive looks like and how accurate they are.

Reviewed by Dr. Richard Holsman, PT, DPT, NCS · Last reviewed November 13, 2026 · For clinician education

⚠️ For clinicians

For clinician education; special tests support but do not replace a full examination. This page is a reference for physical therapists, occupational therapists, athletic trainers, students and other clinicians. Patients with joint or spine pain should be examined by a licensed clinician.

For the ACL, the Lachman test is the best single test and a positive pivot shift is very specific. Meniscus tests are only moderately accurate, so combine them with the history.

On this page

Accuracy at a glance

TestTarget conditionSnSp+LR−LRSource
Lachman testACL rupture (pooled, 28 studies)85%94%——[1]
Anterior drawer testACL rupture, chronic (pooled)92%91%——[1]
Pivot shift testACL rupture (pooled)24%98%——[1]
Posterior drawer testChronic isolated PCL tear (clinical exam led by the posterior drawer)90%99%——[2]
McMurray testMeniscal tear (pooled) (+ more below)70%71%——[3]
Thessaly test (20°)Meniscal tear (pooled)75%87%——[4]
Joint-line tendernessMeniscal tear (pooled) (+ more below)63%77%——[3]
Valgus and varus stress testsMCL lesion, pain on valgus stress at 30° (general practice, MRI reference)——2.3—[5]

Sn = sensitivity, Sp = specificity, LR = likelihood ratio. A dash means the source we checked did not report that value.

How to read the accuracy numbers

  • Sensitivity: of people who have the condition, the share with a positive test. A highly sensitive test that is negative helps rule the condition out.
  • Specificity: of people without the condition, the share with a negative test. A highly specific test that is positive helps rule it in.
  • Positive likelihood ratio (+LR): how much a positive result raises the odds. About 5–10 is a moderate shift; above 10 is large.
  • Negative likelihood ratio (−LR): how much a negative result lowers the odds. About 0.1–0.2 is a moderate-to-large shift; near 1 means little change.
  • Values depend on the study’s patients, examiners and reference standard. Many studies are small, so treat single-study numbers with caution.

Knee special tests, step by step

Each test is described in our own words. Compare with the uninvolved side and stop if the test provokes severe pain.

Lachman test

Purpose
Tests the anterior cruciate ligament (ACL).
Patient position
Supine, knee bent 20–30°, thigh relaxed.
How to perform[6]
  1. Stabilize the distal femur with one hand.
  2. Hold the proximal tibia with the other hand, thumb on the joint line.
  3. Pull the tibia forward.
Positive finding
Increased forward glide of the tibia compared with the other knee, and/or a soft or absent end point.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
ACL rupture (pooled, 28 studies)[1]85%94%——
Likelihood ratios not reported in the abstract.

Anterior drawer test

Purpose
Tests the ACL at 90° of knee flexion.
Patient position
Supine, hip flexed 45°, knee flexed 90°, foot flat.
How to perform[6]
  1. Sit gently on the foot to stabilize it.
  2. Grasp the proximal tibia with thumbs on the joint line and make sure the hamstrings are relaxed.
  3. Pull the tibia forward.
Positive finding
Increased forward translation compared with the other knee.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
ACL rupture, chronic (pooled)[1]92%91%——
Not accurate in acute injuries, per the same review.

Pivot shift test

Purpose
Reproduces the rotational instability of an ACL-deficient knee.
Patient position
Supine, fully relaxed.
How to perform[6]
  1. Start with the knee straight and the tibia turned inward.
  2. Apply a valgus (inward-at-the-knee) force.
  3. Slowly bend the knee.
Positive finding
A clunk or shift as the subluxed lateral tibial plateau reduces at about 20–40° of flexion. Often hard to elicit in an awake, guarding patient.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
ACL rupture (pooled)[1]24%98%——
Very specific in acute and chronic injuries; poor sensitivity.

Posterior drawer test

Purpose
Tests the posterior cruciate ligament (PCL).
Patient position
Supine, hip flexed 45°, knee flexed 90°, foot stabilized.
How to perform[6]
  1. First look from the side for a posterior sag of the tibia and feel the normal step-off of the tibial plateau in front of the femoral condyles.
  2. Push the proximal tibia backward.
Positive finding
Increased backward translation and loss of the normal tibial step-off.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Chronic isolated PCL tear (clinical exam led by the posterior drawer)[2]90%99%——
Accuracy of the overall exam by fellowship-trained surgeons; the posterior drawer with step-off palpation was the most accurate component.

McMurray test

Purpose
Looks for a meniscus tear by rotating and bending the loaded knee.
Patient position
Supine.
How to perform[6]
  1. Fully bend the knee.
  2. For the medial meniscus, turn the foot outward and apply a valgus force while slowly straightening the knee; for the lateral meniscus, turn the foot inward with a varus force.
Positive finding
A painful click or clunk felt at the joint line.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Meniscal tear (pooled)[3]70%71%——
Meniscal tear (pooled, later review)[4]61%84%——

Thessaly test (20°)

Purpose
A weight-bearing rotation test for meniscus tears.
Patient position
Standing on the tested leg with the knee bent 20°, holding your hands for balance.
How to perform[6]
  1. Test the good knee first.
  2. Ask the patient to rotate the body and knee inward and outward three times while keeping the knee at 20°.
Positive finding
Joint-line pain or a sense of locking or catching.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Meniscal tear (pooled)[4]75%87%——

Joint-line tenderness

Purpose
Palpation for a meniscus tear.
Patient position
Supine or sitting, knee bent to about 90°.
How to perform[6]
  1. Palpate along the medial and lateral joint lines with your thumb.
  2. Compare with the other knee.
Positive finding
Tenderness on the joint line on the injured side.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Meniscal tear (pooled)[3]63%77%——
Meniscal tear (pooled, later review)[4]83%83%——

Valgus and varus stress tests

Purpose
Test the medial (MCL) and lateral (LCL) collateral ligaments.
Patient position
Supine, thigh supported on the table.
How to perform[6]
  1. With the knee at 0° and then at 30° of flexion, stabilize the thigh.
  2. Push the knee inward with the ankle moved outward (valgus) to stress the MCL.
  3. Push the knee outward with the ankle moved inward (varus) to stress the LCL.
Positive finding
Pain and/or increased opening compared with the other knee. Laxity in full extension suggests additional damage beyond the collateral ligament.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
MCL lesion, pain on valgus stress at 30° (general practice, MRI reference)[5]——2.3—
Adding laxity at 30° and history items raised the +LR to 6.4.

What we left out

Varus stress (LCL) accuracy, Apley’s test, Ege’s test, patellar apprehension, posterior sag and the Ottawa knee rule are not shown with numbers. We only show accuracy numbers we could check against the original study or review.

Sources, review and disclosures

Graded citations

How we grade sources. A = systematic review or meta-analysis. B = single prospective diagnostic accuracy study. C = small, retrospective or case-control study, or a clinical prediction rule that has only been derived (not yet validated). D = expert clinical opinion (our test descriptions). Every accuracy number on this page was checked against the cited abstract or full text on November 13, 2026. If we could not check a number, we left it out and say “accuracy data not verified.”

  1. Grade A Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther. 2006;36(5):267-288. doi:10.2519/jospt.2006.2011 (abstract). PubMed 16715828
  2. Grade C Rubinstein RA Jr, Shelbourne KD, McCarroll JR, VanMeter CD, Rettig AC. The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med. 1994;22(4):550-557. doi:10.1177/036354659402200419 (abstract; 39 participants). PubMed 7943523
  3. Grade A Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2007;37(9):541-550. doi:10.2519/jospt.2007.2560 (abstract). PubMed 17939613
  4. Grade A Smith BE, Thacker D, Crewesmith A, Hall M. Special tests for assessing meniscal tears within the knee: a systematic review and meta-analysis. Evid Based Med. 2015;20(3):88-97. doi:10.1136/ebmed-2014-110160 (abstract). PubMed 25724195
  5. Grade B Kastelein M, Wagemakers HP, Luijsterburg PA, Verhaar JA, Koes BW, Bierma-Zeinstra SM. Assessing medial collateral ligament knee lesions in general practice. Am J Med. 2008;121(11):982-988. doi:10.1016/j.amjmed.2008.05.041 (abstract; reference standard MRI; 134 patients). PubMed 18954845
  6. Grade D Holsman Physical Therapy clinical guidance. Patient position, test steps and positive findings written in our own words by Holsman physical therapists and reviewed by Dr. Richard Holsman, PT, DPT, NCS. Expert opinion, not a research source.

Reviewer

Reviewed by Dr. Richard Holsman, PT, DPT, NCS (Board-Certified Clinical Specialist in Neurologic Physical Therapy), founder of Holsman Physical Therapy. Last reviewed: November 13, 2026.

Change log

  • November 13, 2026: Page published. Test descriptions written in our own words; accuracy values checked against the cited sources.

Review policy

We re-check every number on this page against its source at least once a year, and sooner if a source is updated, a better study is published or a reader reports a problem. Changes are listed in the change log with the date. To report an error, contact us.

Licensing

Test descriptions, steps and the accuracy summaries are original text by Holsman Physical Therapy. Accuracy values are individual numbers cited with credit to the original studies; no tables, figures or text from journals, textbooks or other websites are reproduced. Linking to a source does not imply its endorsement. Demonstration videos, when added, will be filmed by Holsman physical therapists with consenting adult models.

Conflict of interest and advertising

This page is published by Holsman Physical Therapy and Wellness, P.C., which runs outpatient and in-home therapy practices; that is our only commercial interest. The page carries no advertising, no sponsorship and no affiliate links, and we received no payment from any source for it. Holsman Physical Therapy is not affiliated with the authors or publishers cited, and they do not endorse this website.

For clinician education; special tests support but do not replace a full examination. A positive or negative test changes the probability of a condition; it does not make a diagnosis. Interpret every result with the history, the rest of the examination, imaging when indicated, and clinical judgment. Stop any test that provokes severe pain or neurological symptoms.

Common Questions

What is the best test for an ACL tear?

The Lachman test. In the Benjaminse 2006 meta-analysis its pooled sensitivity was 85% and specificity 94%. A positive pivot shift is very specific (98%) but often negative in an awake patient.

How accurate is the McMurray test?

Moderate. Pooled sensitivity and specificity were 70% and 71% in Hegedus 2007, and 61% and 84% in Smith 2015. Joint-line tenderness and the Thessaly test performed similarly or better in the later review.

Referring a Patient?

Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits.

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