Abstract
Objective:To evaluate the effectiveness of the Lever Sign test (LST) for diagnosing anterior cruciate ligament (ACL) ruptures.Methods:This prospective trial was conducted from January to December 2020. A total of 73 patients, aged 18 to 65 years, presenting with chief complaint as acute knee pain rated < 7/10 on a verbal numerical rating scale, having a minimum 20 to 120° range of motion and undergoing magnetic resonance imaging (MRI) were enrolled. Detailed history, physical examination and standard radiographic evaluation were done in all subjects. For the assessment of the integrity of the ACL, the anterior drawer, Lachman, pivot-shift and LST were performed on each symptomatic knee by a senior orthopedic consultant with a minimum five years post-fellowship experience. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the LST were recorded with respect to standard reference MRI findings.Results:Out of a total of 73 patients, there were 49 (67.1%) males. Mean age was noted to be 34.5±8.1 years. Area of residence was rural among 42 (57.5%) patients. Mean time since injury was noted to be 11.2±4.6 months. The MRI findings showed ACL intact among 31 (42.4%) patients while it showed ACL torn among 42 (57.5%) patients. The LST showed positive findings for ACL rupture in 39 (53.5%) patients while it was negative in remaining 34 (46.5%). The sensitivity, specificity, PPV, NPV and accuracy of LST with respect to standard reference finding (MRI) was found to be 86%, 90%, 92%, 82% and 88% respectively.Conclusion:The LST was found to have good specificity, sensitivity, PPV, NPV and accuracy to detect the status of the ACL. The LST is easy to perform can be used along with other standard assessment techniques to further increase the validation of the status of the ACL diagnosis.
Highlights
The anterior cruciate ligament (ACL) is the most frequently involved knee injuries.[1]
For the assessment of the integrity of the ACL, the anterior drawer, Lachman, pivot-shift and Lever Sign test (LST) were performed on each symptomatic knee by a senior orthopedic consultant with a minimum five years post-fellowship experience
We found the LST to have a better sensitivity than pivot-shift test (86% vs. 81%) while sensitivity was comparable to anterior drawer and Lachman tests
Summary
The anterior cruciate ligament (ACL) is the most frequently involved knee injuries.[1]. Pak J Med Sci March - April 2022 (Part-II) Vol 38 No 4 www.pjms.org.pk 946 for diagnosing ACL ruptures All these tests are known to produce good specificity and sensitivity yet these have their own limitations like the influence of the individual guarding because of pain linked with rapidly translating or twisting a potential injury whereas it is known that partial tears are not easy to diagnose.[6]. Even these manual methods have some limitations, yet, these have some advantages over MRI as these are totally non-invasive and performed while these are inexpensive contrary to MRI.[7]. Some researchers have shown LST to be better or equal to other manual tests while some others have shown it to be below par in comparison to other available manual options.[8,9] No data about the validity of LST exists in Pakistan so the present research was aimed at evaluating effectiveness of LST for diagnosing ACL ruptures
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