Apley’s Distraction Test: Procedure, Positive Sign & Accuracy

Published August 25, 2026 Read time 4 min read Readers 74
Apley’s Distraction Test

What Is Apley’s Distraction Test Used For?

Apley’s distraction test is an orthopedic special test that checks the integrity of the collateral ligaments of the knee. These are the medial collateral ligament (MCL) and the lateral collateral ligament (LCL). Clinicians use it with the Apley compression (grind) test. Alan Graham Apley first described his knee examination for meniscus tears in 1947. The two phases are often grouped together as one test and help separate ligament pain from meniscal pain.

The logic comes down to joint loading. Distraction unloads the menisci and stresses the collateral ligaments and joint capsule instead. If rotation under traction hurts, the ligaments are the more likely source.

How to Perform Apley’s Distraction Test

  1. Position the patient prone (face down) with the affected knee flexed to 90°.
  2. Stabilize the thigh. The examiner places their own knee on the back of the patient’s thigh.
  3. Grasp the leg just above the ankle.
  4. Apply traction. Pull the tibia upward, toward the ceiling, to distract the knee joint.
  5. Rotate while holding traction. Turn the tibia internally and externally, and note any pain or excessive movement.

The examiner should compare both knees. Testing the uninjured side first gives a baseline for the patient’s normal range and pain response.

What Is a Positive Result?

A positive test reproduces pain during rotation under distraction. The location of the pain points to the ligament involved:

  • Pain on the medial side: suggests medial collateral ligament (MCL) damage.
  • Pain on the lateral side: suggests lateral collateral ligament (LCL) damage.

Compare this with the compression phase. Pain with compression but not with distraction suggests a meniscal injury, while a positive distraction test suggests a ligament injury. Pain in both phases is non-specific and calls for further testing.

How Accurate Is Apley’s Test?

The test is useful but should never be used alone. A 2015 study (Blyth et al., PubMed ID 26243431) found the test’s overall accuracy was as low as 58%. A systematic review and meta-analysis by Hegedus et al. (2007, PubMed ID 17939613) reported a sensitivity of 61% and a specificity of 70% for meniscal tears. Another factor is that reported accuracy varies widely, largely because the test is described inconsistently across sources. The figures above relate mainly to the compression (meniscus) phase. Evidence specific to the distraction phase is more limited.

In practice, clinicians combine Apley’s test with:

  • Valgus stress test (MCL)
  • Varus stress test (LCL)
  • McMurray test and Thessaly test (menisci)
  • Imaging such as MRI when the diagnosis is unclear

The systematic review “Does this patient have a torn meniscus or ligament of the knee?” (Solomon et al., PubMed ID 11585485) reviews the clinical examination of these injuries.

Tips for Better Results

  • Keep the patient relaxed. Muscle guarding can mask or mimic a positive sign.
  • Use steady, gentle traction. Sudden force can cause false positives.
  • Always compare with the opposite knee.
  • Interpret findings alongside the patient’s history, swelling and mechanism of injury.

Frequently Asked Questions (FAQ)

What is Apley’s distraction test used for?
It assesses the integrity of the medial and lateral collateral ligaments of the knee.

What does pain on the medial side mean?
Pain on the inner knee during traction and rotation suggests medial collateral ligament injury.

What does pain on the lateral side mean?
Pain on the outer knee suggests lateral collateral ligament injury.

What is the difference between the distraction and compression tests?
Distraction pulls the joint apart and stresses the ligaments. Compression presses the tibia into the femur and stresses the menisci.

Can Apley’s test diagnose a torn meniscus on its own?
No. Published accuracy is modest, so it should be combined with other tests and imaging.

What position is the patient in?
Prone, with the knee flexed to 90°.

Is the test painful?
It may reproduce the patient’s pain if there is an injury. It should be performed gently.

Do I need an MRI if the test is positive?
Not always. A clinician decides based on the full examination, symptoms and how severe the injury seems.

References

  1. Hegedus EJ et al. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. PubMed ID 17939613. Link
  2. Blyth M et al. Diagnostic accuracy of Apley’s test. PubMed ID 26243431.
  3. Solomon DH et al. Does this patient have a torn meniscus or ligament of the knee? JAMA 2001. PubMed ID 11585485.
  4. Apley AG. The diagnosis of meniscus injuries: some new clinical methods. J Bone Joint Surg Am. 1947.
  5. OrthoFixar. Apley Distraction Test.
  6. Clinical Tests for the Musculoskeletal System, 3rd Edition.
  7. Dutton’s Orthopaedic Examination, Evaluation, and Intervention, 3rd Edition.