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Diagnostic accuracy of physical examination for anterior knee instability: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Acknowledgments

A special thanks to four collaborators to this systematic review: Louis-Philippe Baisi, Nicole Friel, Hiba Abdul Mannan and Zakia Islam.

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Authors and Affiliations

  1. Division of Orthopedic Surgery, Department of Surgery, McMaster University, 4E15- 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada

    Marie-Claude Leblanc, Marcin Kowalczuk & Olufemi R. Ayeni

  2. Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada

    Nicole Andruszkiewicz

  3. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    Nicole Simunovic, Forough Farrokhyar & Olufemi R. Ayeni

  4. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Forough Farrokhyar

  5. Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, CO, USA

    Travis Lee Turnbull

  6. Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA

    Richard E. Debski

Authors
  1. Marie-Claude Leblanc
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  2. Marcin Kowalczuk
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Correspondence to Olufemi R. Ayeni.

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Leblanc, MC., Kowalczuk, M., Andruszkiewicz, N. et al. Diagnostic accuracy of physical examination for anterior knee instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 23, 2805–2813 (2015). https://doi.org/10.1007/s00167-015-3563-2

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  • DOI: https://doi.org/10.1007/s00167-015-3563-2

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