Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 8, pp 1895–1903 | Cite as

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

  • Carola F. van EckEmail author
  • Michel P. J. van den Bekerom
  • Freddie H. Fu
  • Rudolf W. Poolman
  • Gino M. M. J. Kerkhoffs



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.


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.


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.


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.


Anterior cruciate ligament Lachman Pivot shift Anterior drawer Sensitivity Specificity 


Conflict of interest

Dr. Freddie H. Fu discloses that his department receives research and educational funding from Smith and Nephew, not directly related to the research presented in this manuscript. The other authors report no disclosures.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Carola F. van Eck
    • 1
    • 2
    Email author
  • Michel P. J. van den Bekerom
    • 2
  • Freddie H. Fu
    • 1
  • Rudolf W. Poolman
    • 3
  • Gino M. M. J. Kerkhoffs
    • 2
  1. 1.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA
  2. 2.Orthopaedic Research Centre Amsterdam, Department of Orthopaedic SurgeryAcademic Medical CentreAmsterdamThe Netherlands
  3. 3.Department of Orthopaedic Surgery, Joint ResearchOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands

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