Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2013

01.08.2013 | Knee

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

verfasst von: Carola F. van Eck, Michel P. J. van den Bekerom, Freddie H. Fu, Rudolf W. Poolman, Gino M. M. J. Kerkhoffs

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 8/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.
Literatur
1.
Zurück zum Zitat Anderson AF, Lipscomb AB (1989) Preoperative instrumented testing of anterior and posterior knee laxity. Am J Sports Med 17:387–392PubMedCrossRef Anderson AF, Lipscomb AB (1989) Preoperative instrumented testing of anterior and posterior knee laxity. Am J Sports Med 17:387–392PubMedCrossRef
2.
Zurück zum Zitat Anderson AF, Snyder RB, Federspiel CF, Lipscomb AB (1992) Instrumented evaluation of knee laxity: a comparison of five arthrometers. Am J Sports Med 20:135–140PubMedCrossRef Anderson AF, Snyder RB, Federspiel CF, Lipscomb AB (1992) Instrumented evaluation of knee laxity: a comparison of five arthrometers. Am J Sports Med 20:135–140PubMedCrossRef
3.
Zurück zum Zitat Benjaminse A, Gokeler A, van der Schans CP (2006) Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 36:267–288PubMed Benjaminse A, Gokeler A, van der Schans CP (2006) Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 36:267–288PubMed
4.
Zurück zum Zitat Bhandari M, Montori VM, Swiontkowski MF, Guyatt GH (2003) User’s guide to the surgical literature: how to use an article about a diagnostic test. J Bone Joint Surg Am 85-A:1133–1140PubMed Bhandari M, Montori VM, Swiontkowski MF, Guyatt GH (2003) User’s guide to the surgical literature: how to use an article about a diagnostic test. J Bone Joint Surg Am 85-A:1133–1140PubMed
5.
Zurück zum Zitat Bomberg BC, McGinty JB (1990) Acute hemarthrosis of the knee: indications for diagnostic arthroscopy. Arthroscopy 6:221–225PubMedCrossRef Bomberg BC, McGinty JB (1990) Acute hemarthrosis of the knee: indications for diagnostic arthroscopy. Arthroscopy 6:221–225PubMedCrossRef
6.
Zurück zum Zitat Crawford R, Walley G, Bridgman S, Maffulli N (2007) Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull 84:5–23PubMedCrossRef Crawford R, Walley G, Bridgman S, Maffulli N (2007) Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull 84:5–23PubMedCrossRef
7.
Zurück zum Zitat Dahlstedt LJ, Dalen N (1989) Knee laxity in cruciate ligament injury. Value of examination under anesthesia. Acta Orthop Scand 60:181–184PubMedCrossRef Dahlstedt LJ, Dalen N (1989) Knee laxity in cruciate ligament injury. Value of examination under anesthesia. Acta Orthop Scand 60:181–184PubMedCrossRef
8.
Zurück zum Zitat DeHaven KE (1980) Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med 8:9–14PubMedCrossRef DeHaven KE (1980) Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med 8:9–14PubMedCrossRef
9.
Zurück zum Zitat Donaldson WF 3rd, Warren RF, Wickiewicz T (1985) A comparison of acute anterior cruciate ligament examinations. Initial versus examination under anesthesia. Am J Sports Med 13:5–10PubMedCrossRef Donaldson WF 3rd, Warren RF, Wickiewicz T (1985) A comparison of acute anterior cruciate ligament examinations. Initial versus examination under anesthesia. Am J Sports Med 13:5–10PubMedCrossRef
10.
Zurück zum Zitat Harilainen A (1987) Evaluation of knee instability in acute ligamentous injuries. Ann Chir Gynaecol 76:269–273PubMed Harilainen A (1987) Evaluation of knee instability in acute ligamentous injuries. Ann Chir Gynaecol 76:269–273PubMed
11.
Zurück zum Zitat Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 58:159–172PubMed Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 58:159–172PubMed
12.
Zurück zum Zitat Jonsson T, Althoff B, Peterson L, Renstrom P (1982) Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparative study of the Lachman test and the anterior drawer sign. Am J Sports Med 10:100–102PubMedCrossRef Jonsson T, Althoff B, Peterson L, Renstrom P (1982) Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparative study of the Lachman test and the anterior drawer sign. Am J Sports Med 10:100–102PubMedCrossRef
13.
Zurück zum Zitat Katz JW, Fingeroth RJ (1986) The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries. Am J Sports Med 14:88–91PubMedCrossRef Katz JW, Fingeroth RJ (1986) The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries. Am J Sports Med 14:88–91PubMedCrossRef
14.
Zurück zum Zitat Kim SJ, Kim HK (1995) Reliability of the anterior drawer test, the pivot shift test, and the Lachman test. Clin Orthop Relat Res 317:237–242PubMed Kim SJ, Kim HK (1995) Reliability of the anterior drawer test, the pivot shift test, and the Lachman test. Clin Orthop Relat Res 317:237–242PubMed
15.
Zurück zum Zitat Learmonth DJ (1991) Incidence and diagnosis of anterior cruciate injuries in the accident and emergency department. Injury 22:287–290PubMedCrossRef Learmonth DJ (1991) Incidence and diagnosis of anterior cruciate injuries in the accident and emergency department. Injury 22:287–290PubMedCrossRef
16.
Zurück zum Zitat Lee JK, Yao L, Phelps CT, Wirth CR, Czajka J, Lozman J (1988) Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests. Radiology 166:861–864PubMed Lee JK, Yao L, Phelps CT, Wirth CR, Czajka J, Lozman J (1988) Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests. Radiology 166:861–864PubMed
17.
Zurück zum Zitat Lintner DM, Kamaric E, Moseley JB, Noble PC (1995) Partial tears of the anterior cruciate ligament. Are they clinically detectable? Am J Sports Med 23:111–118PubMedCrossRef Lintner DM, Kamaric E, Moseley JB, Noble PC (1995) Partial tears of the anterior cruciate ligament. Are they clinically detectable? Am J Sports Med 23:111–118PubMedCrossRef
18.
Zurück zum Zitat Liu SH, Osti L, Henry M, Bocchi L (1995) The diagnosis of acute complete tears of the anterior cruciate ligament. Comparison of MRI, arthrometry and clinical examination. J Bone Joint Surg Br 77:586–588PubMed Liu SH, Osti L, Henry M, Bocchi L (1995) The diagnosis of acute complete tears of the anterior cruciate ligament. Comparison of MRI, arthrometry and clinical examination. J Bone Joint Surg Br 77:586–588PubMed
19.
Zurück zum Zitat Losee RE, Johnson TR, Southwick WO (1978) Anterior subluxation of the lateral tibial plateau. A diagnostic test and operative repair. J Bone Joint Surg Am 60:1015–1030PubMed Losee RE, Johnson TR, Southwick WO (1978) Anterior subluxation of the lateral tibial plateau. A diagnostic test and operative repair. J Bone Joint Surg Am 60:1015–1030PubMed
20.
Zurück zum Zitat Lucie RS, Wiedel JD, Messner DG (1984) The acute pivot shift: clinical correlation. Am J Sports Med 12:189–191PubMedCrossRef Lucie RS, Wiedel JD, Messner DG (1984) The acute pivot shift: clinical correlation. Am J Sports Med 12:189–191PubMedCrossRef
21.
Zurück zum Zitat Marshall JL, Wang JB, Furman W, Girgis FG, Warren R (1975) The anterior drawer sign: what is it? J Sports Med 3:152–158PubMedCrossRef Marshall JL, Wang JB, Furman W, Girgis FG, Warren R (1975) The anterior drawer sign: what is it? J Sports Med 3:152–158PubMedCrossRef
22.
Zurück zum Zitat Mitsou A, Vallianatos P (1988) Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparison between the Lachman test and the anterior drawer sign. Injury 19:427–428PubMedCrossRef Mitsou A, Vallianatos P (1988) Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparison between the Lachman test and the anterior drawer sign. Injury 19:427–428PubMedCrossRef
23.
Zurück zum Zitat Muriuki MG, Tuason DA, Tucker BG, Harner CD (2011) Changes in tibiofemoral contact mechanics following radial split and vertical tears of the medial meniscus an in vitro investigation of the efficacy of arthroscopic repair. J Bone Joint Surg Am 93:1089–1095 Muriuki MG, Tuason DA, Tucker BG, Harner CD (2011) Changes in tibiofemoral contact mechanics following radial split and vertical tears of the medial meniscus an in vitro investigation of the efficacy of arthroscopic repair. J Bone Joint Surg Am 93:1089–1095
24.
Zurück zum Zitat Musahl V, Ayeni OR, Citak M, Irrgang JJ, Pearle AD, Wickiewicz TL (2010) The influence of bony morphology on the magnitude of the pivot shift. Knee Surg Sports Traumatol Arthrosc 18:1232–1238PubMedCrossRef Musahl V, Ayeni OR, Citak M, Irrgang JJ, Pearle AD, Wickiewicz TL (2010) The influence of bony morphology on the magnitude of the pivot shift. Knee Surg Sports Traumatol Arthrosc 18:1232–1238PubMedCrossRef
25.
Zurück zum Zitat Musahl V, Bedi A, Citak M, O’Loughlin P, Choi D, Pearle AD (2010) Effect of single-bundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees. Am J Sports Med 39:289–295PubMedCrossRef Musahl V, Bedi A, Citak M, O’Loughlin P, Choi D, Pearle AD (2010) Effect of single-bundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees. Am J Sports Med 39:289–295PubMedCrossRef
26.
Zurück zum Zitat Musahl V, Bell KM, Tsai AG, Costic RS, Allaire R, Zantop T, Irrgang JJ, Fu FH (2007) Development of a simple device for measurement of rotational knee laxity. Knee Surg Sports Traumatol Arthrosc 15:1009–1012PubMedCrossRef Musahl V, Bell KM, Tsai AG, Costic RS, Allaire R, Zantop T, Irrgang JJ, Fu FH (2007) Development of a simple device for measurement of rotational knee laxity. Knee Surg Sports Traumatol Arthrosc 15:1009–1012PubMedCrossRef
27.
Zurück zum Zitat Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38:1591–1597 Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38:1591–1597
28.
Zurück zum Zitat Musahl V, Voos J, O’Loughlin PF, Stueber V, Kendoff D, Pearle AD (2010) Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc 18:1208–1213PubMedCrossRef Musahl V, Voos J, O’Loughlin PF, Stueber V, Kendoff D, Pearle AD (2010) Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc 18:1208–1213PubMedCrossRef
29.
Zurück zum Zitat Noyes FR, Bassett RW, Grood ES, Butler DL (1980) Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am 62(687–95):757 Noyes FR, Bassett RW, Grood ES, Butler DL (1980) Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am 62(687–95):757
30.
Zurück zum Zitat Noyes FR, Grood ES, Cummings JF, Wroble RR (1991) An analysis of the pivot shift phenomenon. The knee motions and subluxations induced by different examiners. Am J Sports Med 19:148–155PubMedCrossRef Noyes FR, Grood ES, Cummings JF, Wroble RR (1991) An analysis of the pivot shift phenomenon. The knee motions and subluxations induced by different examiners. Am J Sports Med 19:148–155PubMedCrossRef
31.
Zurück zum Zitat Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K (2007) A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 15(7):851–856PubMedCrossRef Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K (2007) A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 15(7):851–856PubMedCrossRef
32.
Zurück zum Zitat Sandberg R, Balkfors B, Henricson A, Westlin N (1986) Stability tests in knee ligament injuries. Arch Orthop Trauma Surg 106:5–7PubMedCrossRef Sandberg R, Balkfors B, Henricson A, Westlin N (1986) Stability tests in knee ligament injuries. Arch Orthop Trauma Surg 106:5–7PubMedCrossRef
33.
Zurück zum Zitat Scholten RJ, Opstelten W, van der Plas CG, Bijl D, Deville WL, Bouter LM (2003) Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis. J Fam Pract 52:689–694PubMed Scholten RJ, Opstelten W, van der Plas CG, Bijl D, Deville WL, Bouter LM (2003) Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis. J Fam Pract 52:689–694PubMed
34.
Zurück zum Zitat Schwarz W, Hagelstein J, Minholz R, Schierlinger M, Danz B, Gerngross H (1997) Manual ultrasound of the knee joint. A general practice method for diagnosis of fresh rupture of the anterior cruciate ligament. Unfallchirurg 100:280–285PubMedCrossRef Schwarz W, Hagelstein J, Minholz R, Schierlinger M, Danz B, Gerngross H (1997) Manual ultrasound of the knee joint. A general practice method for diagnosis of fresh rupture of the anterior cruciate ligament. Unfallchirurg 100:280–285PubMedCrossRef
35.
Zurück zum Zitat Simonsen O, Jensen J, Mouritsen P, Lauritzen J (1984) The accuracy of clinical examination of injury of the knee joint. Injury 16:96–101PubMedCrossRef Simonsen O, Jensen J, Mouritsen P, Lauritzen J (1984) The accuracy of clinical examination of injury of the knee joint. Injury 16:96–101PubMedCrossRef
36.
Zurück zum Zitat Slocum DB, James SL, Larson RL, Singer KM (1976) Clinical test for anterolateral rotary instability of the knee. Clin Orthop Relat Res 118:63–69PubMed Slocum DB, James SL, Larson RL, Singer KM (1976) Clinical test for anterolateral rotary instability of the knee. Clin Orthop Relat Res 118:63–69PubMed
37.
Zurück zum Zitat Strand T, Solheim E (1995) Clinical tests versus KT-1000 instrumented laxity test in acute anterior cruciate ligament tears. Int J Sports Med 16:51–53PubMedCrossRef Strand T, Solheim E (1995) Clinical tests versus KT-1000 instrumented laxity test in acute anterior cruciate ligament tears. Int J Sports Med 16:51–53PubMedCrossRef
38.
Zurück zum Zitat Tonino AJ, Huy J, Schaafsma J (1986) The diagnostic accuracy of knee testing in the acutely injured knee. Initial examination versus examination under anaesthesia with arthroscopy. Acta Orthop Belg 52:479–487PubMed Tonino AJ, Huy J, Schaafsma J (1986) The diagnostic accuracy of knee testing in the acutely injured knee. Initial examination versus examination under anaesthesia with arthroscopy. Acta Orthop Belg 52:479–487PubMed
39.
Zurück zum Zitat Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4:84–93PubMedCrossRef Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4:84–93PubMedCrossRef
40.
Zurück zum Zitat Tsai AG, Musahl V, Steckel H, Bell KM, Zantop T, Irrgang JJ, Fu FH (2008) Rotational knee laxity: reliability of a simple measurement device in vivo. BMC Musculoskelet Disord 9:35PubMedCrossRef Tsai AG, Musahl V, Steckel H, Bell KM, Zantop T, Irrgang JJ, Fu FH (2008) Rotational knee laxity: reliability of a simple measurement device in vivo. BMC Musculoskelet Disord 9:35PubMedCrossRef
41.
Zurück zum Zitat Wirth CJ, Kolb M (1985) Hemarthrosis and the isolated anterior cruciate ligament lesion. Value of clinical diagnosis. Unfallchirurg 88:419–423PubMed Wirth CJ, Kolb M (1985) Hemarthrosis and the isolated anterior cruciate ligament lesion. Value of clinical diagnosis. Unfallchirurg 88:419–423PubMed
42.
Zurück zum Zitat Zantop T, Brucker PU, Vidal A, Zelle BA, Fu FH (2007) Intraarticular rupture pattern of the ACL. Clin Orthop Relat Res 454:48–53PubMedCrossRef Zantop T, Brucker PU, Vidal A, Zelle BA, Fu FH (2007) Intraarticular rupture pattern of the ACL. Clin Orthop Relat Res 454:48–53PubMedCrossRef
Metadaten
Titel
Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia
verfasst von
Carola F. van Eck
Michel P. J. van den Bekerom
Freddie H. Fu
Rudolf W. Poolman
Gino M. M. J. Kerkhoffs
Publikationsdatum
01.08.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 8/2013
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-2250-9

Weitere Artikel der Ausgabe 8/2013

Knee Surgery, Sports Traumatology, Arthroscopy 8/2013 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.