Reliability and Diagnostic Accuracy of the Lachman Test Performed in a Prone Position

Mulligan, Edward P.; Harwell, Jordan L.; Robertson, William J.

doi:10.2519/jospt.2011.3761

Cited by 36 publications

(53 citation statements)

References 26 publications

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“…Previous studies have established the Lachman and Pivot shift tests to have outstanding specificity but only moderate sensitivity. 1,[3][4][5][6][7] One of the compelling qualities regarding the Lever Sign from previous published studies was the improved sensitivity that approached 100% for this examination technique. [6][7] The findings of the current study could not replicate this high sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…the fact that all current evaluation techniques (Lachman and Anterior Drawer tests) have displayed a similar high level of specificity. 1,[3][4] Additionally, the pivot shift test is an assessment of rotational stability while the Lachman, Anterior Drawer, and Lever Sign are all assessments of translational stability. As with previous investigations this investigation did not evaluate the reliability of the Lever Sign.…”

Section: Discussionmentioning

confidence: 99%

“…Of these tests, the Lachman test is considered the clinical gold standard for diagnosing this injury because of its well-established sensitivity, specificity, likelihood ratios, and ease of application for patients of any size. [1][2][3][4][5] The accuracy of this test is enhanced with an appreciation for the anterior tibial translation endpoint quality in addition to the interpreting the magnitude of the translational asymmetry between limbs. 5 Recently, a new test has been proposed that is equally easy to perform and may be a more convenient assessment for the patient when trying to identify both partial and full tears of the ACL.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Forwards and backwards citation tracking identified 12 potentially relevant articles which were also retrieved. Fourteen articles were finally included, of which 11 were published in English [19,[23][24][25][26][27][28][29][30][31][32] and three in German [33][34][35]. Additional file 2: Table S2 lists the reasons for excluding 28 articles that were included in one or more of the previous five systematic reviews.…”

Section: Study Selectionmentioning

confidence: 99%

“…Of the 14 included articles, 10 had a prospective study design [19,23,24,[28][29][30][32][33][34][35], two used a retrospective design [26,27] and for two studies [25,31] the design was unclear (Table 1).…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review

et al. 2014

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Background: Numerous clinical tests are used in the diagnosis of anterior cruciate ligament (ACL) injury but their accuracy is unclear. The purpose of this study is to evaluate the diagnostic accuracy of clinical tests for the diagnosis of ACL injury. Methods: Study Design: Systematic review. The review protocol was registered through PROSPERO (CRD42012002069). Electronic databases (PubMed, MEDLINE, EMBASE, CINAHL) were searched up to 19th of June 2013 to identify diagnostic studies comparing the accuracy of clinical tests for ACL injury to an acceptable reference standard (arthroscopy, arthrotomy, or MRI). Risk of bias was appraised using the QUADAS-2 checklist. Index test accuracy was evaluated using a descriptive analysis of paired likelihood ratios and displayed as forest plots. Results: A total of 285 full-text articles were assessed for eligibility, from which 14 studies were included in this review. Included studies were deemed to be clinically and statistically heterogeneous, so a meta-analysis was not performed. Nine clinical tests from the history (popping sound at time of injury, giving way, effusion, pain, ability to continue activity) and four from physical examination (anterior draw test, Lachman's test, prone Lachman's test and pivot shift test) were investigated for diagnostic accuracy. Inspection of positive and negative likelihood ratios indicated that none of the individual tests provide useful diagnostic information in a clinical setting. Most studies were at risk of bias and reported imprecise estimates of diagnostic accuracy. Conclusion: Despite being widely used and accepted in clinical practice, the results of individual history items or physical tests do not meaningfully change the probability of ACL injury. In contrast combinations of tests have higher diagnostic accuracy; however the most accurate combination of clinical tests remains an area for future research. Clinical relevance: Clinicians should be aware of the limitations associated with the use of clinical tests for diagnosis of ACL injury.

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Diagnosis of Failed ACL Reconstruction

Cohen

Arliani

Astur

et al. 2013

Revision ACL Reconstruction

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Reliability and Diagnostic Accuracy of the Lachman Test Performed in a Prone Position

Cited by 36 publications

References 26 publications

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

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

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review

Diagnosis of Failed ACL Reconstruction

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