The Lachman test is the most sensitive and the pivot shift the most specific test for the diagnosis of ACL rupture
2006; Elsevier BV; Volume: 52; Issue: 1 Linguagem: Inglês
10.1016/s0004-9514(06)70069-1
ISSN1449-2059
Autores Tópico(s)Total Knee Arthroplasty Outcomes
ResumoTo asses the validity of three physical diagnostic tests for the demonstration of rupture of the anterior cruciate ligament (ACL): the anterior drawer test, the Lachman test, and the pivot shift test. Meta-analysis of diagnostic studies. From computerised searches of Medline (1966–2004) and Embase (1980–2004), publications were selected that were written in English, French, German, or Dutch and in which the value of at least one physical diagnostic test for rupture of the ACL was assessed in comparison with the findings from arthrotomy, arthroscopy, or MRI as the reference standard. Two investigators independently selected the publications, assessed the methodological quality, and extracted data using a standardised protocol. Wherever appropriate and possible, an estimate was made of the (pooled) sensitivity, specificity, and positive and negative predictive value of each test with the aid of a meta-analysis. There were 17 studies identified. None of these reported blinded assessment of test, and only 2 performed the gold standard in all included patients. Summary estimates of sensitivity and specificity were 62% (95% CI 42 to 78%) and 88% (95% CI 83 to 92%) for the anterior drawer test, 86% (95% CI 76 to 92%) and 91% (95% CI 79 to 96%) for the Lachman test, and 32% and 98% (95% CIs could not be calculated) for the pivot shift test, respectively. Physical diagnostic tests may be useful in the diagnosis of ACL ruptures. The clinical relevance of the test results, however, depends largely on the prior probability of the presence of such a rupture and is therefore different for general practitioners and specialists.
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