Value of clinical tests in diagnosing anterior cruciate ligament injuries: A systematic review and meta-analysis

Huang, Zijian; Liu, Zhihao; Fan, Changfeng; Zou, Miao; Chen, Jiyan

doi:10.1097/md.0000000000029263

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…However, in patients with ligament tears, range of motion may be limited due to pain and swelling in the knee, and therefore this test may be difficult to use. 27 Sokal et al 25 reported the pooled +LR value of this test as (6.34), which is consistent with our study. In the study of Huang et al 27 the pooled +LR value of the ADT was evaluated as equal to (3.57).…”

Section: Statement Of Principal Findingssupporting

confidence: 92%

“…27 Sokal et al 25 reported the pooled +LR value of this test as (6.34), which is consistent with our study. In the study of Huang et al 27 the pooled +LR value of the ADT was evaluated as equal to (3.57).…”

Section: Statement Of Principal Findingssupporting

confidence: 92%

“…In the study of Huang. et al 27 the test with the lowest -LR value was reported as the lever sign test, and in the study of Abruscato et al 10 -LR value of lever sign test was equal to (0.22). In our study, the -LR value of Lachman's test was calculated in the range of (0.13-0.31).…”

Section: Statement Of Principal Findingsmentioning

confidence: 94%

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Diagnostic Accuracy of Clinical Test for Anterior Cruciate Ligament Injury: Systematic Review

Yasemin,

Pyun,

Lee

et al. 2023

J Kor Phys Ther

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The aim of this study was to conduct a systematic review of randomized controlled studies from 2012 to present that explore the diagnostic accuracy of clinical tests used for diagnosing anterior cruciate ligament (ACL) injury. Methods: Study design: Systematic review. Literature search of the PubMed and Scholar databases was conducted using keywords related to diagnostic accuracy of clinical tests for ACL injury. The PRISMA Guidelines were followed to conduct this study. The Cochrane Risk of Bias Tool was utilized to assess the quality of each included study. Results: As a result, 8 studies were included, and 6 clinical tests used in ACL tears were evaluated for diagnostic accuracy. The pivot shift test was reported as having the highest +LR (29.5) value with a sensitivity of 59% and a specificity of 98%. However, the test with the lowest -LR value was the lever test, and the values were as follows: -LR (0.08), +LR (4.7), specificity (80%), sensitivity (94%). Conclusion:In this study, it was concluded that a single clinical test is not sufficient to determine the presence of ACL injury. Test combinations have a higher diagnostic accuracy than a single test. In this study, the accuracy of the clinical tests was examined without considering the amount of ACL rupture and acute-chronic condition. Further research is required to examine the impact of these two factors on diagnostic accuracy of clinical test.

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Section: Statement Of Principal Findingssupporting

confidence: 92%

Section: Statement Of Principal Findingssupporting

confidence: 92%

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Diagnostic Accuracy of Clinical Test for Anterior Cruciate Ligament Injury: Systematic Review

Yasemin,

Pyun,

Lee

et al. 2023

J Kor Phys Ther

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“…All patients underwent a preoperative assessment of anterior knee laxity by measuring ATT with BLU-DAT. The Lachman test was used to assess ATT, as it has proven to have high diagnostic accuracy [ 7 ]. Measurements in the ACL-injured group were performed by two investigators: a sports-medicine experienced orthopaedic surgeon (examiner A) and (examiner B).…”

Section: Methodsmentioning

confidence: 99%

BLU‐DAT: a new reliable and accurate arthrometer for measuring anterior knee laxity

Colosio

Scaini

Motta

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Although many arthrometers have been developed to assess anterior knee laxity, reliability and diagnostic accuracy of these devices are still debated. The aim of the present study was to evaluate the validity of a new arthrometer in the outpatient setting, with the hypothesis that it had good validity in terms of reliability and diagnostic accuracy. Methods Seventy-eight subjects (39 with ACL injury and 39 with normal ACL) were tested. ATT was assessed by means of the Lachman test at 30° of flexion with a new testing device (BLU-DAT) under three different loading conditions: 7 kg (69 N), 9 kg (88 N) and maximum (MMT). The tests were performed on both knees to obtain SSD. In the ACL injury group, the tests were performed by two examiners and one of them repeated a second test series. Inter- and intra-observer reliability were assessed with the intraclass correlation coefficients (ICCs) for the average SSD measures. In the normal-ACL group, the analysis was performed with the same testing setup. Side-to-side difference measures of the two groups at every loading condition were compared by Student’s t test. Data of test series were dichotomized based on the threshold value of 3-mm SSD as pathological ATT and 2 × 2 contingency tables were used to assess diagnostic accuracy. Results The ICCs for intra-observer reliability at 7-kg (69 N), 9-kg (88 N) and MMT measurements were 0.781, 0.855 and 0.913, respectively. The ICC for inter-observer reliability at 7-kg (69 N), 9-kg (88 N) and MMT measurements were 0.701, 0.845 and 0.834, respectively. Comparison between the two groups showed a significant mean difference ranging from 3.4 mm for 7-kg (69 N) load to 4.6 mm for MMT. Overall accuracy ranged from 84.6% for 7-kg load to 98.7% for MMT. Conclusion The BLU-DAT has proven to be an instrument with good intra- and inter-observer reliability and very good accuracy in the diagnosis of ACL injuries in the outpatient setting. So, the BLU-DAT can be a new useful tool in everyday clinical practice to assist in the diagnosis of ACL injury. Level of evidence II.

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The Stabilized Lachman’s Test: A Highly Sensitive, Specific and Accurate Test to Diagnose Acute ACL Tears

Wetzler,

Ruzzi,

Keller

et al. 2024

Journal of Orthopaedic Experience &Amp; Innovation

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Background The Lachman’s Test (LT) is the one of the most relied tests for the clinical diagnosis of a torn Anterior Cruciate Ligament (ACL). The accuracy of the traditional LT is largely dependent on the skill and experience of the observer as well as the timing of the knee was examined in respect to the injury. Wroble & Linderfeld first described the stabilized Lachman’s Test (SLT) in 1988. The examiner’s thigh is placed underneath and supports the thigh while the examiner’s hand (the opposite one to the extremity being examined) is used to stabilize the thigh. Purpose The purpose of this study was to prospectively analyze the sensitivity, specificity, and accuracy of the SLT to diagnose acute ACL tears. The hypothesis is that the SLT is a very sensitive, specific, and accurate test to diagnose ACL deficiency in acutely injured knees. Methods Two hundred patients with acute knee injuries were prospectively studied. All were examined within 30 days of injury (average – 8.3 days). Any patients with a previous ipsilateral or contralateral ligament knee injury were excluded from this study. All knees were examined prior to examining or interviewing the patient. There were 83 (41.5%) females and 117 (58.5%) males with an average age of 27.3 years. The SLT results were not graded but recorded as a positive or negative result. ACL tears were definitively diagnosed with MRI. Results On the initial examination there were 46 (23%) patients that had SLT that was recorded as positive and 154 (77%) that were considered negative. Forty-eight patients (24%) had a torn ACL and in 152 (76%) knees, the ACL was found to be intact by MRI. The SLT produced 44 (22%) true positives and 150 (75%) true negatives as well as 4 (2%) false negatives and 2 (1%) false positives. The resulting sensitivity was 91.7%, specificity was 98.7% and accuracy was 97%. The positive predictive value was 95.7% with the negative predictive value of 97.0%. The positive likelihood ratio was 69.9 and the negative likelihood ration was 0.085 Discussion The SLT is a highly sensitive, specific and accurate test for diagnosing ACL tears in the knee. The advantage of the SLT is that it allows the patient to relax the leg easily because the thigh is resting on a stable object. The examiner will feel the lower extremity relax by increased pressure on their own thigh and as soon as they feel this the SLT is performed. The examiner’s hand can now easily stabilize the thigh and control the leg’s rotation even in patients with large thighs or with clinicians with smaller hands, thus increasing the reliability and reproducibility of the SLT. Conclusion The SLT is highly sensitive, specific and accurate and has advantages over the standard LT. The SLT is a valuable tool in the armament of the clinician’s physical exam and diagnostic testing. It is beneficial for clinicians to at least try and compare it to the standard LT, especially those with less clinical experience.

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Value of clinical tests in diagnosing anterior cruciate ligament injuries: A systematic review and meta-analysis

Cited by 3 publications

References 27 publications

Diagnostic Accuracy of Clinical Test for Anterior Cruciate Ligament Injury: Systematic Review

Diagnostic Accuracy of Clinical Test for Anterior Cruciate Ligament Injury: Systematic Review

BLU‐DAT: a new reliable and accurate arthrometer for measuring anterior knee laxity

The Stabilized Lachman’s Test: A Highly Sensitive, Specific and Accurate Test to Diagnose Acute ACL Tears

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