Marie-Claude Leblanc1, Marcin Kowalczuk1, Nicole Andruszkiewicz2, Nicole Simunovic3, Forough Farrokhyar3,4, Travis Lee Turnbull5, Richard E Debski6, Olufemi R Ayeni7,8. 1. Division of Orthopedic Surgery, Department of Surgery, McMaster University, 4E15- 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada. 2. Department of Public Health Sciences, Queen's University, Kingston, ON, Canada. 3. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 4. Department of Surgery, McMaster University, Hamilton, ON, Canada. 5. Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, CO, USA. 6. Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA. 7. Division of Orthopedic Surgery, Department of Surgery, McMaster University, 4E15- 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada. ayenif@mcmaster.ca. 8. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ayenif@mcmaster.ca.
Abstract
PURPOSE: Determining diagnostic accuracy of Lachman, pivot shift and anterior drawer tests versus gold standard diagnosis (magnetic resonance imaging or arthroscopy) for anterior cruciate ligament (ACL) insufficiency cases. Secondarily, evaluating effects of: chronicity, partial rupture, awake versus anaesthetized evaluation. METHODS: Searching MEDLINE, EMBASE and PubMed identified studies on diagnostic accuracy for ACL insufficiency. Studies identification and data extraction were performed in duplicate. Quality assessment used QUADAS tool, and statistical analyses were completed for pooled sensitivity and specificity. RESULTS: Eight studies were included. Given insufficient data, pooled analysis was only possible for sensitivity on Lachman and pivot shift test. During awake evaluation, sensitivity for the Lachman test was 89 % (95 % CI 0.76, 0.98) for all rupture types, 96 % (95 % CI 0.90, 1.00) for complete ruptures and 68 % (95 % CI 0.25, 0.98) for partial ruptures. For pivot shift in awake evaluation, results were 79 % (95 % CI 0.63, 0.91) for all rupture types, 86 % (95 % CI 0.68, 0.99) for complete ruptures and 67 % (95 % CI 0.47, 0.83) for partial ruptures. CONCLUSION: Decreased sensitivity of Lachman and pivot shift tests for partial rupture cases and for awake patients raised suspicions regarding the accuracy of these tests for diagnosis of ACL insufficiency. This may lead to further research aiming to improve the understanding of the true accuracy of these physical diagnostic tests and increase the reliability of clinical investigation for this pathology. LEVEL OF EVIDENCE: IV.
PURPOSE: Determining diagnostic accuracy of Lachman, pivot shift and anterior drawer tests versus gold standard diagnosis (magnetic resonance imaging or arthroscopy) for anterior cruciate ligament (ACL) insufficiency cases. Secondarily, evaluating effects of: chronicity, partial rupture, awake versus anaesthetized evaluation. METHODS: Searching MEDLINE, EMBASE and PubMed identified studies on diagnostic accuracy for ACL insufficiency. Studies identification and data extraction were performed in duplicate. Quality assessment used QUADAS tool, and statistical analyses were completed for pooled sensitivity and specificity. RESULTS: Eight studies were included. Given insufficient data, pooled analysis was only possible for sensitivity on Lachman and pivot shift test. During awake evaluation, sensitivity for the Lachman test was 89 % (95 % CI 0.76, 0.98) for all rupture types, 96 % (95 % CI 0.90, 1.00) for complete ruptures and 68 % (95 % CI 0.25, 0.98) for partial ruptures. For pivot shift in awake evaluation, results were 79 % (95 % CI 0.63, 0.91) for all rupture types, 86 % (95 % CI 0.68, 0.99) for complete ruptures and 67 % (95 % CI 0.47, 0.83) for partial ruptures. CONCLUSION: Decreased sensitivity of Lachman and pivot shift tests for partial rupture cases and for awake patients raised suspicions regarding the accuracy of these tests for diagnosis of ACL insufficiency. This may lead to further research aiming to improve the understanding of the true accuracy of these physical diagnostic tests and increase the reliability of clinical investigation for this pathology. LEVEL OF EVIDENCE: IV.
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