Cargando…

Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries

BACKGROUND: The lever sign test is a new physical examination tool to diagnose anterior cruciate ligament (ACL) tears. Preliminary results suggest almost 100% sensitivity and specificity to diagnose acute and chronic complete ACL tears and clinically significant partial tears as compared with magnet...

Descripción completa

Detalles Bibliográficos
Autores principales: Jarbo, Keith A., Hartigan, David E., Scott, Kelly L., Patel, Karan A., Chhabra, Anikar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
54
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639970/
https://www.ncbi.nlm.nih.gov/pubmed/29051898
http://dx.doi.org/10.1177/2325967117729809
_version_ 1783270961220419584
author Jarbo, Keith A.
Hartigan, David E.
Scott, Kelly L.
Patel, Karan A.
Chhabra, Anikar
author_facet Jarbo, Keith A.
Hartigan, David E.
Scott, Kelly L.
Patel, Karan A.
Chhabra, Anikar
author_sort Jarbo, Keith A.
collection PubMed
description BACKGROUND: The lever sign test is a new physical examination tool to diagnose anterior cruciate ligament (ACL) tears. Preliminary results suggest almost 100% sensitivity and specificity to diagnose acute and chronic complete ACL tears and clinically significant partial tears as compared with magnetic resonance imaging (MRI). PURPOSE: To assess the sensitivity and specificity of the lever sign test for the diagnosis of acute ACL injuries, as compared to MRI. We also aimed to determine the accuracy of the lever sign test compared with 3 other tests (anterior drawer, Lachman, and pivot shift) when performed by providers of various training levels, and with the patient awake or under anesthesia. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: We evaluated patients with a chief concern of acute (≤4 weeks) knee pain seen between October 2014 and January 2015, with a thorough history, physical examination, and standard radiographs. MRI was the reference standard; patients without an MRI evaluation were excluded. The 4 physical examination maneuvers were performed on each symptomatic knee during the initial clinic visit (for nonsurgical patients) or under anesthesia in the operating room (for surgical patients) by a randomly assigned undergraduate student, medical student, orthopaedic resident, or orthopaedic fellow. The senior author trained all staff to perform the lever sign test. Statistical analyses were performed. RESULTS: Of 102 patients, 54 were surgical (28 female, 26 male), and 48 were nonsurgical (16 female, 32 male); the mean patient age was 23 years (range, 15-66 years). The overall accuracy of the lever sign test was 77% (63% sensitivity, 90% specificity); the accuracy was similar between patients under anesthesia and awake (77% vs 76%, respectively). There were no significant differences when comparing the sensitivity and specificity of the lever sign test with patients under anesthesia and awake (sensitivity: under anesthesia, 86%, and awake, 68% [P = .40]; specificity: under anesthesia, 85%, and awake, 96% [P = .17]). Furthermore, the accuracy of the lever sign test was similar when performed on female versus male patients (75% vs 79%, respectively) or when performed by undergraduate students and medical students compared with orthopaedic residents and fellows (84% vs 88%, respectively). CONCLUSION: Our study results challenge the exceptional sensitivity and specificity values (both 100%) of the lever sign test, as reported by the original author of the test.
format Online
Article
Text
id pubmed-5639970
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-56399702017-10-19 Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries Jarbo, Keith A. Hartigan, David E. Scott, Kelly L. Patel, Karan A. Chhabra, Anikar Orthop J Sports Med 54 BACKGROUND: The lever sign test is a new physical examination tool to diagnose anterior cruciate ligament (ACL) tears. Preliminary results suggest almost 100% sensitivity and specificity to diagnose acute and chronic complete ACL tears and clinically significant partial tears as compared with magnetic resonance imaging (MRI). PURPOSE: To assess the sensitivity and specificity of the lever sign test for the diagnosis of acute ACL injuries, as compared to MRI. We also aimed to determine the accuracy of the lever sign test compared with 3 other tests (anterior drawer, Lachman, and pivot shift) when performed by providers of various training levels, and with the patient awake or under anesthesia. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: We evaluated patients with a chief concern of acute (≤4 weeks) knee pain seen between October 2014 and January 2015, with a thorough history, physical examination, and standard radiographs. MRI was the reference standard; patients without an MRI evaluation were excluded. The 4 physical examination maneuvers were performed on each symptomatic knee during the initial clinic visit (for nonsurgical patients) or under anesthesia in the operating room (for surgical patients) by a randomly assigned undergraduate student, medical student, orthopaedic resident, or orthopaedic fellow. The senior author trained all staff to perform the lever sign test. Statistical analyses were performed. RESULTS: Of 102 patients, 54 were surgical (28 female, 26 male), and 48 were nonsurgical (16 female, 32 male); the mean patient age was 23 years (range, 15-66 years). The overall accuracy of the lever sign test was 77% (63% sensitivity, 90% specificity); the accuracy was similar between patients under anesthesia and awake (77% vs 76%, respectively). There were no significant differences when comparing the sensitivity and specificity of the lever sign test with patients under anesthesia and awake (sensitivity: under anesthesia, 86%, and awake, 68% [P = .40]; specificity: under anesthesia, 85%, and awake, 96% [P = .17]). Furthermore, the accuracy of the lever sign test was similar when performed on female versus male patients (75% vs 79%, respectively) or when performed by undergraduate students and medical students compared with orthopaedic residents and fellows (84% vs 88%, respectively). CONCLUSION: Our study results challenge the exceptional sensitivity and specificity values (both 100%) of the lever sign test, as reported by the original author of the test. SAGE Publications 2017-10-11 /pmc/articles/PMC5639970/ /pubmed/29051898 http://dx.doi.org/10.1177/2325967117729809 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle 54
Jarbo, Keith A.
Hartigan, David E.
Scott, Kelly L.
Patel, Karan A.
Chhabra, Anikar
Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries
title Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries
title_full Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries
title_fullStr Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries
title_full_unstemmed Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries
title_short Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries
title_sort accuracy of the lever sign test in the diagnosis of anterior cruciate ligament injuries
topic 54
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639970/
https://www.ncbi.nlm.nih.gov/pubmed/29051898
http://dx.doi.org/10.1177/2325967117729809
work_keys_str_mv AT jarbokeitha accuracyoftheleversigntestinthediagnosisofanteriorcruciateligamentinjuries
AT hartigandavide accuracyoftheleversigntestinthediagnosisofanteriorcruciateligamentinjuries
AT scottkellyl accuracyoftheleversigntestinthediagnosisofanteriorcruciateligamentinjuries
AT patelkarana accuracyoftheleversigntestinthediagnosisofanteriorcruciateligamentinjuries
AT chhabraanikar accuracyoftheleversigntestinthediagnosisofanteriorcruciateligamentinjuries