Methods to diagnose acute anterior cruciate ligament rupture: A meta-analysis of physical examinations with and without anaesthesia

Carola F. van Eck, Michel P.J. van den Bekerom, Freddie H. Fu, Rudolf W. Poolman, Gino M.M.J. Kerkhoffs

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1895-1903
Number of pages9
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume21
Issue number8
DOIs
Publication statusPublished - 1 Aug 2013
Externally publishedYes

Keywords

  • Anterior cruciate ligament
  • Anterior drawer
  • Lachman
  • Pivot shift
  • Sensitivity
  • Specificity

Fingerprint

Dive into the research topics of 'Methods to diagnose acute anterior cruciate ligament rupture: A meta-analysis of physical examinations with and without anaesthesia'. Together they form a unique fingerprint.

Cite this