Accurate interpretation of the Lachman test.

In a consecutive series of patients with knee complaints, tibial rotation consistently affected the interpretation of the Lachman test (passive anterior tibial translation in slight knee flexion). To perform the Lachman test correctly, the anterior tibial force must be applied posteromedially on the proximal tibia. This is best achieved by having the leg under examination on the same side of the bed as the examiner, and with slight external tibial rotation. Reaching across the bed to examine either leg can create either false positive or false negative Lachman results due to inadvertent tibial rotation (internal tibial rotation decreases translation) and inaccurate comparisons of the injured and normal legs. The importance of tibial rotation must be recognized if the Lachman test is to be used reliably and with maximum sensitivity.