Understanding the Lever Sign Test Assessment
An alternative, potentially easier test to assess for rupture of the **Anterior Cruciate Ligament (ACL)**.
Watch How It's Done
How do I start?
Patient is supine. The examiner places a clenched fist or rigid object **under the patient's calf** (proximal tibia).
What happens?
The examiner then applies a strong, downward pressure to the **distal thigh/femur**, attempting to extend the knee.
In Plain English
What Does a Positive Result Mean?
In a healthy knee, the downward pressure will cause the heel to **lift off the table**. If the **ACL is torn**, the heel will **fail to lift** or lift only minimally due to anterior translation of the tibia.
Helpful Tip:
The principle is that the intact ACL prevents the tibia from rotating anteriorly, forcing the heel up. If the ACL is ruptured, the tibia slides forward, preventing the lever action.
Safety First
This guide is to help you understand what happens in a clinic. Do not try to diagnose yourself. If you have severe pain, swelling, or cannot put weight on your leg, please visit an urgent care center or your doctor immediately.
Other Knee Tests
Pivot Shift Test
To dynamically assess for **anterolateral rotatory instability** of the knee, which is highly indicative of a **complete ACL tear**.
Posterior Drawer Test of the Knee
To assess the integrity of the **Posterior Cruciate Ligament (PCL)**.
Posterior Sag Sign (Gravity Drawer Test)
To detect a rupture of the **Posterior Cruciate Ligament (PCL)** by observing the effect of gravity.
Slocum Test (Anterolateral Rotatory Instability)
To assess for **anterolateral rotatory instability** and the function of the **Anterolateral Ligament** (a dynamic variant of the Anterior Drawer).