Purpose: The aims of this meta-analysis were to determine the sensitivity and specificity of the Lachman, pivot shift and anterior drawer test for acute complete ACL rupture in the office setting and under anaesthesia. It was hypothesized that the Lachman test is the most sensitive and the pivot shift test the most specific. Secondly, it was hypothesized that the sensitivity and specificity of all three exams increases when the examination is performed under anaesthesia.
Methods: An electronic database search was performed using MEDLINE and EMBASE. All cross-sectional and cohort studies comparing one or more physical examination tests for diagnosing acute complete ACL rupture to an accepted reference standard such as arthroscopy, arthrotomy and MRI were included.
Results: Twenty studies were identified and included. The overall sensitivity of the Lachman test was 0.81 and the specificity 0.81; with anaesthesia, the sensitivity was 0.91 and the specificity 0.78. For the anterior drawer test, the sensitivity was 0.38 and the specificity 0.81; with anaesthesia, the sensitivity was 0.63 and the specificity 0.91. The sensitivity of the pivot shift test was 0.28 and the specificity 0.81; with anaesthesia, the sensitivity was 0.73 and the specificity 0.98.
Conclusion: In the office setting, the Lachman test has the highest sensitivity for diagnosing an acute, complete ACL rupture, while all three tests had comparable specificity. When the examination was performed under anaesthesia, the Lachman test still obtained the highest sensitivity, but the pivot shift test was the most specific.
Level Of Evidence: Meta-analysis of diagnostic test accuracy, Level II.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00167-012-2250-9 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
ACL reconstruction success requires additional correction of tibial slope, rotational instability, and meniscus pathology: Meniscal repair failure increases knee rotational laxity.
Arthroscopy
March 2025
Department of Orthopedic Surgery, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL, USA. Electronic address:
The anterior cruciate ligament (ACL) and medial and lateral menisci are essential contributors of both anteroposterior (AP) and rotational knee stability. Multiple studies have shown both ACL-deficient knees lead to increased risk of meniscal injury, as well as multiple types of meniscal tears or deficiency leading to increased risk of ACL tear or ACL reconstruction (ACLR) failures. All amenable meniscal tears, such as red-red peripheral tears, radial tears, root tears, lateral meniscal oblique radial tears (LMORTs), and ramp lesions should be attempted to be repaired at time of ACLR.
View Article and Find Full Text PDFPerceptual decoupling in the sustained attention to response task is likely: comment on Bedi, Russell, & Helton (2024).
Exp Brain Res
March 2025
Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, USA.
Recent work by Bedi et al. (Experimental Brain Research 242(8):2033-2040, 2024) posits that perceptual decoupling in the sustained attention to response task (SART) is unlikely. In this commentary, we challenge their broad titular claim by revisiting two important studies: Smallwood et al.
View Article and Find Full Text PDFInvestigating Injuries to the Anterolateral Corner of the Knee: Imaging Insights Into Kaplan Fibers and the Anterolateral Ligament in Anterior Cruciate Ligament Tears.
Orthop J Sports Med
February 2025
Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Background: The intricate relationship between anterolateral ligament (ALL) and Kaplan fibers (KF) injuries in acute traumatic anterior cruciate ligament (ACL) tears presents a diagnostic challenge. Understanding these associations is crucial for enhancing therapeutic strategies and patient outcomes.
Purpose: To elucidate the prevalence of ALL and KF injuries among patients with acute ACL tears and examine their correlations with other imaging findings.
Evaluation of the Stability, Revision Rate, and Complication Profile of Combined Anterior Cruciate Ligament Reconstruction with Lateral Extra-Articular Tenodesis and Hughston Procedure in Anterior Cruciate Ligament and Medial Collateral Ligament Injury: An 8-Year Cohort Study.
Orthop J Sports Med
March 2025
Clinica II, IRCCS, Istituto Ortopedico Rizzoli, Via Pupilli, Bologna, Italy.
Background: Anterior cruciate ligament (ACL) tears combined with medial collateral ligament (MCL) injury has been associated with an increased rate of ACL reconstruction (ACLR) failure, high-grade pivot shift (PS), and lower return to sports rate. On the other hand, medial-sided procedures in the setting of ACLR are associated with knee stiffness and arthrofibrosis.
Purpose/hypothesis: This study aimed to compare clinical scores, objective knee laxity, failure, and complication rates in 2 different patient groups.
All-Epiphyseal Versus Micheli-Kocher Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review.
J Pediatr Orthop
March 2025
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Ontario, Canada.
Background: Early physeal-sparing anterior cruciate ligament reconstruction (ACLR) is considered the optimal treatment method in the skeletally immature population to preserve the integrity of the knee joint while reducing the risk of growth disturbances and angular deformities. Contemporary treatment algorithms recommend the use of all-epiphyseal (AE) or Micheli-Kocher (MK) ACLR techniques in patients with considerable growth remaining. Nevertheless, no research exists comparing the 2 techniques.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!