The arthroscopical and radiological corelation of lever sign test for the diagnosis of anterior cruciate ligament rupture

Devecı, Alper; Çankaya, Deniz; Yılmaz, Serdar; Özdemir, Güzelali; Arslantaş, Emrah; Bozkurt, Murat

doi:10.1186/s40064-015-1628-9

Cited by 30 publications

(64 citation statements)

References 25 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%

“…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. In fact, the number of false negatives was greater than true positives resulting in an inadequate level of screening for the injury regardless if the index test was compared to a gold or reference standard.…”

Section: Discussionmentioning

confidence: 99%

“…For the Lachman test performed in supine, pooled data from meta-analy ses by Benjaminse et al, 1 Jackson et al, 14 In contrast, this study could not replicate the diagnostic accuracy found in other investigations for the Lever Sign. [6][7] One of the attractive features of the Lever Sign is the simplicity of its interpretation. There should be little debate regarding the rise of the heel.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7] Retrospectively, the relatively wide diagnostic accuracy confidence intervals that were reported may have suggested that an even larger sample size to improve the measurement precision of point estimates regarding the diagnostic truthfulness for the Lever Sign. Another acknowledged shortcoming of this study is that 41 of the 60 patients were classified without the benefit of direct, intraoperative visual assessment of the status of the ACL and had to be assigned to a category based on a cluster of clinical impressions and signs.…”

Section: Discussionmentioning

confidence: 99%

“…6 Recently investigators evaluated the arthroscopic and radiologic correlation of the Lever Sign findings to detect ACL injury when the subject was preanesthesia and under anesthesia. 7 These investigators found nearly perfect sensitivity (94, 98%) in pre-anesthesia and under-anesthesia conditions, respectively. The Lachman, Pivot Shift and Anterior Drawer tests demonstrated slightly less sensitivity under anesthesia (all at 88%) with much lower sensitivity during the pre-anesthesia assessment at 80, 62, and 60% respectively.…”

Section: Introductionmentioning

confidence: 96%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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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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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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Higher sensitivity with the lever sign test for diagnosis of anterior cruciate ligament rupture in the emergency department

Guiraud

Silvestre

Bastin

et al. 2021

Arch Orthop Trauma Surg

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The arthroscopical and radiological corelation of lever sign test for the diagnosis of anterior cruciate ligament rupture

Cited by 30 publications

References 25 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

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

Higher sensitivity with the lever sign test for diagnosis of anterior cruciate ligament rupture in the emergency department

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