Diagnostic Accuracy of Lever Sign Test in Acute, Chronic, and Postreconstructive ACL Injuries

Gürpınar, Tahsin; Polat, Barış; Polat, Ayşe Esin; Çarkçı, Engin; Öztürkmen, Yusuf

doi:10.1155/2019/3639693

Cited by 18 publications

(44 citation statements)

References 22 publications

(32 reference statements)

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“…The anterior drawer test has a sensitivity of 56% and a specificity of 82% and is a sign of ACL rupture. It is more sensitive for fibres in the anteromedial beam[ 99 , 100 ]. There is a variety of the anterior drawer test that is externally rotated and specifically allows assessment of posterior-internal structures[ 102 ].…”

Section: Resultsmentioning

confidence: 99%

“…Lachman test: This is the main test to be carried out on an acute injury[ 100 ]. It is performed with the knee in a 30° knee flexion position and a force is applied in an anterior direction.…”

Section: Resultsmentioning

confidence: 99%

“…It is important to note the end point of tibial displacement. This end point is soft or weak when there is a break in the ACL[ 100 - 105 ].…”

Section: Resultsmentioning

confidence: 99%

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Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children

Chekroun¹,

Velázquez-Saornil²,

Vicente³

et al. 2022

WJO

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Background: Knee examination guidelines in minors are intended to aid decision-making in the management of knee instability. Clinical question: A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence. A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children. Key findings: there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary. Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed. Clinical application: In the absence of a strong evidence base, these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible. Following this expert consensus, surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test ++, and may include an anterior drawer test + and a Lachman test +. If these conditions are not present, the conservative approach should be chosen, as the anatomical and functional development of children, together with a physiotherapy programme, may improve the evolution of the injury.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children

Chekroun¹,

Velázquez-Saornil²,

Vicente³

et al. 2022

WJO

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show abstract

“…With the original data omitted (400 tests with no false positive or false negative results), the LR + decreased from 128.0 to 13.1 indicating verification and case–control bias [ 59 ]. Other studies reporting on the Lever sign test are also at risk of verification bias [ 9 , 18 , 26 , 33 , 39 , 43 , 49 , 72 ]; therefore, results based on time since injury and tear type should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis

Sokal

Norris

Maddox

2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The diagnostic accuracy of clinical tests for anterior cruciate ligament injury has been reported in previous systematic reviews. Numerous studies in these reviews include subjects with additional knee ligament injury, which could affect the sensitivity of the tests. Meta-analyses have also been performed using methods that do not account for the non-independence of sensitivity and specificity, potentially overestimating diagnostic accuracy. The aim of this study was to report the diagnostic accuracy of clinical tests for anterior cruciate ligament tears (partial and complete) without concomitant knee ligament injury. Methods A systematic review with meta-analysis was performed according to the PRISMA guidelines. Meta-analyses included studies reporting the specificity and/or sensitivity of tests with or without concomitant meniscal injury. Where possible, pooled diagnostic estimates were calculated with bivariate random-effects modelling to determine the most accurate effect sizes. Diagnostic accuracy values are presented for the anterior drawer, Lachman, Lever sign and pivot shift tests overall and in acute or post-acute presentations. Results Pooled estimates using a bivariate model for overall sensitivity and specificity respectively were as follows: anterior drawer test 83% [95% CI, 77–88] and 85% [95% CI, 64–95]; Lachman test 81% [95% CI, 73–87] and 85% [95% CI, 73–92]; pivot shift test 55% [95% CI, 47–62] and 94% [95% CI, 88–97]; Lever sign test 83% [95% CI, 68–92] and 91% [95% CI, 83–95]. For specific presentations, the sensitivity and specificity of the Lachman test, respectively, were: complete tears 68% [95% CI, 54–79] and 79% [95% CI, 51–93]; post-acute injuries 70% [95% CI, 57–80] and 77% [95% CI, 53–91]. Conclusions The pivot shift and Lever sign were the best tests overall for ruling in or ruling out an anterior cruciate ligament tear, respectively. The diagnostic accuracy of the Lachman test, particularly in post-acute presentations and for complete tears, is lower than previously reported. Further research is required to establish more accurate estimates for the Lachman test in acute presentations and partial ligament tears using bivariate analysis. Level of evidence III.

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“…Gürpınar et al [25] reported a sensitivity value of 80.6% for Lachman, 77.4% for the Anterior Drawer, 51.6% for the pivot, and 91.9 for the lever test in the acute phase. For the chronic phase, these values were reported as 83.9%, 79.0%, 56.5% and 91.9%, respectively.…”

Section: Quadricepsmentioning

confidence: 99%

Is Lever Test Superior to Lachman, Pivot Shift, Drawer Tests in Diagnosing Anterior Cruciate Ligament Injuries?

İpek¹,

Zehir²,

Dündar³

2022

Cureus

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Introduction: The physical examination in anterior cruciate ligament (ACL) injuries is extremely important, and the Lever test is commonly utilized on ACL evaluation. However, the number and scope of studies on the Lever test is limited. In this prospective cross-sectional study, we aimed to evaluate the effectiveness of the diagnostic values of Lachman, Pivot Shift, Lever, and Anterior Drawer tests in terms of quadriceps atrophy and case phase in ACL injuries.Methods: In this prospective study, diagnostic values of Lachman, Pivot Shift, Lever, and Anterior Drawer tests were examined on 189 patients with positive MRI results as the gold standard.Results: Lever test positivity was significantly more frequent in the group with quadriceps atrophy preoperative and after sedation (p<0.05). Anterior Drawer test positivity was significantly more frequent in the group with positive quadriceps atrophy preoperatively, after sedation and after spinal anesthesia (p<0.05). Lever and Anterior Drawer tests were positively correlated with quadriceps atrophy preop and after sedation (p<0.05). Lever test before surgery, after sedation and after spinal anesthesia in the chronic patient group was more positive than in the acute and subacute groups (p<0.05). Lever test was positively correlated with phase preoperatively, after sedation and after spinal anesthesia (p<0.01). Conclusion:The presence or absence of quadriceps atrophy in patients with acute, sub-acute, or chronic ACL injury has a significant effect on the predictive value of the Lever test. We think that univariate analyzes may give incorrect results when demonstrating predictive value, and it would be more correct to perform multivariate analyzes.

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Diagnostic Accuracy of Lever Sign Test in Acute, Chronic, and Postreconstructive ACL Injuries

Cited by 18 publications

References 22 publications

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children

The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis

Is Lever Test Superior to Lachman, Pivot Shift, Drawer Tests in Diagnosing Anterior Cruciate Ligament Injuries?

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