[RESEARCH] Accuracy of ACL Special Tests

Accuracy of 3 ACL Diagnostic Tests

INTRO:
The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee.

In America, estimates of ACL injury cases range from 80,000 to 250,000 per year, with approximately 100,000 of these patients undergoing ACL reconstruction surgery.

The 3 primary diagnostic assessments of these manual tests are:

Anterior drawer test.
Lachman test.
Pivot shift test.

Hunag et al. (2016), performed a meta-analysis, looking at diagnostic sensitivity and specificity of the 3 assessments to evaluate the diagnostic accuracy of the anterior drawer, Lachman, and pivot shift tests.

RESULTS:

16 studies assessed the accuracy of the 3 tests for diagnosing ACL ruptures & met the inclusion criteria.
Lachman test; most sensitive test to determine ACL tears (87.1%).
Pivot shift test; most specific test (97.5%) & has the highest positive likelihood ratios (LR+) of 16.00.
Lachman test has the lowest negative likelihood ratios (LR−) of 0.17.

CONCLUSIONS:
In cases of suspected ACL injury:

Perform the pivot shift test, as it is very specific and has greater likelihood ratios in diagnosing ACL rupture.
The Lachman test has favorable efficacy in ruling out a diagnosis of ACL rupture.
The anterior drawer test is the least proven of the 3 approaches in diagnosing ACL rupture.

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SOURCE:
Huang et al. 2016. Clinical examination of anterior cruciate ligament rupture: a systematic review and meta-analysis. Acta Orthop Traumatol Turc 2016;50(1):22–31 doi: 10.3944/AOTT.2016.14.0283.

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics.

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