Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis.
Benjaminse A, Gokeler A, van der Schans CP. The Journal of orthopaedic and sports physical therapy 2006 · PMID 16715828 · doi:10.2519/jospt.2006.2011
- Question
- How accurate are the Lachman, anterior drawer and pivot shift tests for diagnosing ACL rupture?
- Design
- Systematic review and meta-analysis of diagnostic accuracy studies.
- Patients
- Patients with suspected ACL rupture examined clinically, with arthroscopy, MRI or arthrometry as reference standard.
- Intervention
- Lachman test, anterior drawer test and pivot shift test
- Comparison
- Reference-standard confirmation of ACL rupture
- Primary outcome
- Pooled sensitivity and specificity of each test
- Key result
- The Lachman test had the best overall sensitivity for ACL rupture, while the pivot shift test was highly specific and useful for ruling the diagnosis in. The anterior drawer test performed better in chronic than acute injuries.
- Limitations
- Included studies were heterogeneous in quality, setting and examiner experience; anaesthesia status varied across studies.
- Impact on practice
- Supports Lachman as the key screening test for ACL injury and pivot shift as a confirmatory test, a commonly examined point in UK assessments.