The lever test evaluates for ACL rupture. With the knee fully extended, the examiner places a closed fist beneath the proximal tibia at the level of the tibial tuberosity, creating slight knee flexion, and then applies a downward force to the distal femur just above the knee, using the fist as a lever. In a negative test with an intact ACL, the applied force causes the patient’s heel to rise off the table. In a positive test indicating ACL rupture, the heel remains in contact with the table desp
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