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the anterior cruciate ligament or ACL keeps the tibia from gliding too far forward the femur ACL tears result in knee and stability various tests have been used to test knees for ACL tears the anterior drawer test is performed with a knee bent to about 90 degrees the tibia is pulled forward if there is no solid endpoint or if the tibia moves too far forward the test indicates that the ACL is torn the Lockman test is considered to be more reliable than the anterior drawer test this is performed with the knee in about 20 to 30 degrees of flexion again the tibia is pulled forward and again too much movement or a soft lacks endpoint suggests an ACL tear the pivot shift test is also commonly used to assess the ACL this test is often difficult to do while the patient is awake because of guarding the knee is held in extension a varus force is applied while the leg is internally rotated and flexed a clunk at about twenty to thirty degrees occurs with ACL tears