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the anterior cruciate ligament or ACL keeps the tibia from gliding too far forward in relation to the femur ACL tears result in knee instability various tests have been used to test knees for ACL tears the anterior drawer test is performed with a knee bent to about 90 the tibia is pulled forward if there is no solid end point 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 a knee in about 20 to 30 of flexion again the tibia is pulled forward and again too much movement or a soft LAX end point 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 varis force is applied while the leg is internally rotated and flexed a clunk at about 20 to 30 occurs with ACL tears