Lachman Test

Description

Lachman test: Knee examination clinical test to examine knee stability in particular the stability of the anterior cruciate ligament (ACL).

History and Controversy

1875 – Georges C Noulis first described the test his thesis

…fixes the thigh with one hand; with the other hand hold the leg just below the knee with the thumb in front and the rest of the fingers behind; then try to push the tibia forward and backward … When only the ACL is broken, forward movement is seen when the knee is slightly flexed…

1960 – Sterling Ritchey, of the Walter Reed Army Hospital in Washington DC, rediscovered the test.

1976 – Joseph Torg eponymised and popularized the described ACL examination as the ‘Lachman Test‘ as a means of preoperative assessment of ACL rupture and postoperatively as an evaluation surgical success. His paper “Clinical Diagnosis of Anterior Cruciate Ligament Instability in the Athlete” was presented before the annual meeting of the American Orthopaedic Society for Sports Medicine in 1976 in New Orleans.

My first exposure to this observation occurred as a resident when presenting a patient to the chief on rounds. Upon turning back the covers, he simply looked at the patient’s knee and stated, “He has a torn anterior cruciate.” The patient’s anterior drawer test was unremarkable; however, surgical findings indicated a complete tear of the anterior cruciate ligament. Thus, a clinical “pearl” had been simply passed on, as Dr. Lachman had done hundreds if not thousands of times before to his students and residents.

Joseph S. Torg, MD (writing about his boss and mentor Dr J.W. Lachman)

Associated Persons

• Georges C Noulis (1849-1919)
• John W Lachman (1919-2007)
• Amédée Bonnet (1809-1858)
• Alessandro Lelli [Lelli Test]

References

• Schindler OS. Surgery for anterior cruciate ligament deficiency: a historical perspective. Knee Surg Sports Traumatol Arthrosc. 2012; 20(1): 5-47.
• Noulis G. Entorse du genou. Thése No. 142. Fac Med, Paris 1875.
• Ritchey SJ. Ligamentous disruption of the knee. A review with analysis of 28 cases. U S Armed Forces Med J. 1960; 11: 167-76.
• Torg JS, Conrad W, Kalen V. Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med. 1976 Mar-Apr;4(2):84-93
• Colombet Ph, Allard M, Bousquet V, Delavigne C, Flur PH. The history of ACL surgery. Maîtrise Orthopédique. N°87 – October 1999