Abstract
Context: The lever sign has been developed and researched, within the last ten years, as an alternative physical examination of the anterior cruciate ligament (ACL). The simplicity and practicality of the test has increased its presence within ACL clinical assessment literature. Multiple studies investigating the lever sign have shown significant sensitivity in diagnosing ACL tears. However, the patient population in the majority of these studies are those reporting with chronic knee injuries. Therefore, there is limited research showing the effectiveness of the lever sign in acute evaluations. This critically appraised topic explores the potential for the lever sign to be significantly effective in diagnosing acute ACL tears within the general population.
Clinical Question: What is the accuracy of the lever sign test compared to the Lachman’s, pivot shift, and anterior drawer tests for the physical examination of acute ruptures to the anterior cruciate ligament (ACL) in the general population?
Summary of Key Findings: The literature yielded three cohort studies evaluating acute anterior cruciate ligament (ACL) ruptures using the lever sign test within the general population. Two of the three studies analyzed the sensitivity of the lever sign, Lachman, and anterior drawer test in emergency department acute ACL injuries. One of the three studies compared the accuracy of the lever sign to the Lachman, anterior drawer and pivot shift clinical assessment of ACL. There were high sensitivity findings of the lever sign in all three cohort studies; however, one cohort study found the Lachman test to be more sensitive and accurate.
Clinical Bottom Line: There is moderate evidence to support high sensitivity of the lever sign as a diagnostic test; however, there is limited research to support the accuracy of the lever sign in acute evaluations of the anterior cruciate ligament (ACL).
Strength of Recommendation: Grade B evidence does exist to show the effectiveness of the lever sign in identifying ACL ruptures during acute evaluations of the general population.
Clinical Question: What is the accuracy of the lever sign test compared to the Lachman’s, pivot shift, and anterior drawer tests for the physical examination of acute ruptures to the anterior cruciate ligament (ACL) in the general population?
Summary of Key Findings: The literature yielded three cohort studies evaluating acute anterior cruciate ligament (ACL) ruptures using the lever sign test within the general population. Two of the three studies analyzed the sensitivity of the lever sign, Lachman, and anterior drawer test in emergency department acute ACL injuries. One of the three studies compared the accuracy of the lever sign to the Lachman, anterior drawer and pivot shift clinical assessment of ACL. There were high sensitivity findings of the lever sign in all three cohort studies; however, one cohort study found the Lachman test to be more sensitive and accurate.
Clinical Bottom Line: There is moderate evidence to support high sensitivity of the lever sign as a diagnostic test; however, there is limited research to support the accuracy of the lever sign in acute evaluations of the anterior cruciate ligament (ACL).
Strength of Recommendation: Grade B evidence does exist to show the effectiveness of the lever sign in identifying ACL ruptures during acute evaluations of the general population.
| Original language | American English |
|---|---|
| Pages | 30 |
| State | Published - 18 Feb 2022 |
| Event | Oklahoma State University Center for Health Sciences Research Week 2022 : Poster Presentation - Oklahoma State University Center for Health Sciences, Tulsa, United States Duration: 14 Feb 2022 → 18 Feb 2022 https://medicine.okstate.edu/research/docs/rw2022_agenda.pdf (Research Week 2022 Agenda) |
Conference
| Conference | Oklahoma State University Center for Health Sciences Research Week 2022 |
|---|---|
| Country/Territory | United States |
| City | Tulsa |
| Period | 14/02/22 → 18/02/22 |
| Internet address |
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Keywords
- lever sign
- anterior cruciate ligament
- acute injury