Physical Examination Tests for the Diagnosis of Posterior Cruciate Ligament Rupture: A Systematic Review

Isolated posterior cruciate ligament (PCL) tears are much less frequent than anterior cruciate ligament (ACL) tears.Abrupt posterior tibial translation (such as dashboard impact), falls in hyperflexion and direct hyperextension trauma are the most frequent mechanisms of production.The anterolateral bundle represents two-thirds of PCL mass and is reconstructed in single-bundle techniques.The PCL has an intrinsic capability for healing. This is the reason why, nowadays, the majority of isolated PCL tears are managed non-operatively, with rehabilitation and bracing.Recent studies have focused on double-bundle reconstruction techniques, as they seem to restore knee kinematics.No significant clinical differences have been established between single versus double-bundle techniques, autograft versus allograft, transtibial tunnel versus tibial inlay techniques or remnant-preserving versus remnant-release techniques.Cite this article: EFORT Open Rev 2017;2:89-96. DOI: 10.1302/2058-5241.2.160009

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“…13 No complete evidence for diagnosis of a PCL tear has been demonstrated with any of these tests. 14 …”

Section: Diagnosis Of Pcl Injuriesmentioning

confidence: 99%

Isolated posterior cruciate ligament tears: an update of management

Vaquero-Picado

Rodríguez-Merchán

2017

EFORT Open Reviews

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“…The specificity of this maneuver has been reported to be 96% and the sensitivity 53%. [9][10] All preliminary exclusion tests were performed by the same examiner who conducted the ACL stability assessment tests.…”

Section: Methodsmentioning

confidence: 99%

The Diagnostic Accuracy of the Lever Sign for Detecting Anterior Cruciate Ligament Injury

Mulligan

Anderson

Watson

et al. 2017

Intl J Sports Phys Ther

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Background: An alternative physical examination procedure for evaluating the integrity of the anterior cruciate ligament (ACL) has been proposed in the literature but has not been validated in a broad population of patients with a symptomatic complaint of knee pain for its diagnostic value.Purpose: To investigate the diagnostic accuracy of the Lever Sign to detect ACL tears and compare the results to Lachman testing in both supine and prone positions.Study design: Prospective, blinded, diagnostic accuracy study.Methods: Sixty-two consecutive patients with a complaint of knee pain were independently evaluated for the status of the ACL's integrity with the Lever Sign and the Lachman test in a prone and supine by a blinded examiner before any other diagnostic assessments were completed.Results: Twenty-four of the 60 patients included in the analysis had a torn ACL resulting in a prevalence of 40%. The sensitivity of the Lever Sign, prone, and supine Lachman tests were 38, 83, and 67 % respectively and the specificity was 72, 89, and 97% resulting in positive likelihood ratios of 1.4, 7.5, and 24 and negative likelihood ratios of 0.86, 0.19, and 0.34 respectively. The positive predictive values were 47, 83, and 94% and the negative predictive values were 63, 89, and 81% respectively. The diagnostic odds ratios were 1.6, 40, and 70 with a number needed to diagnose of 10.3, 1.4, and 1.6 respectively. Conclusions:The results of this study suggest that Lever Sign, in isolation, does not accurately detect the status of the ACL. During the clinical examination, the Lever Sign should be used as an adjunct to the gold standard assessment technique of anterior tibial translation assessment as employed in the Lachman tests in either prone or supine position. Level of Evidence: 2

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“…We will review the pertinent anatomy, biomechanical function of ligamentous structures, mechanisms of injury, and the imaging appearances of specific ligamentous and meniscal injuries in the preoperative setting. Data regarding clinical evaluation of meniscal and ligamentous injuries are highlighted in the Table (2)(3)(4)(5). The role of imaging in the treatment decision-making process will also be discussed where relevant.…”

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confidence: 99%

Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series

Naraghi¹,

White²

2016

Radiology

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Acute knee injuries are a common source of morbidity in athletes and if overlooked may result in chronic functional impairment. Magnetic resonance (MR) imaging of the knee has become the most commonly performed musculoskeletal MR examination and is an indispensable tool in the appropriate management of the injured athlete. Meniscal and ligamentous tearing are the most frequent indications for surgical intervention in sports injuries and an understanding of the anatomy, biomechanics, mechanisms of injury, and patterns of injury are all critical to accurate diagnosis and appropriate management. These will be discussed in reference to meniscal tears and injuries of the cruciate ligaments as well as injuries of the posterolateral and posteromedial corners of the knee. (©) RSNA, 2016.

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Physical Examination Tests for the Diagnosis of Posterior Cruciate Ligament Rupture: A Systematic Review

Cited by 44 publications

References 80 publications

Isolated posterior cruciate ligament tears: an update of management

Isolated posterior cruciate ligament tears: an update of management

The Diagnostic Accuracy of the Lever Sign for Detecting Anterior Cruciate Ligament Injury

Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series

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