June 17, 2017
2 min read

Lever test yielded high sensitivity, specificity in diagnosis of ACL injury

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Results of this level 2 study showed the lever test resulted in high sensitivity, specificity and overall accuracy in the detection of ACL tears.

"The lever test had a similar accuracy to more established ACL instability tests, is well-tolerated by injured patients, and is easy to learn,” Patrick C. McCulloch, MD, told Healio.com/Orthopedics. “As a dichotomous test that does not require grading (either the heel lifts off or it does not), it may be especially useful for those who do not perform ACL examinations routinely.”

Examiners blinded to the presence or absence of ACL injury performed the Lachman, anterior drawer, pivot shift and lever tests on 91 patients aged 16 years to 60 years who presented after a knee injury with subjective swelling or an objective effusion. All patients had an uninjured normal contralateral knee for comparison.

Results showed 78% of patients had MRI-confirmed complete ACL tears. McCulloch and colleagues found the lever test had a sensitivity of 83%, had a specificity of 80% and had an accuracy of 82%, which was not statistically significantly different from that of the Lachman, anterior drawer and pivot shift tests.

According to results, the timing of injury and additional ligament tears did not affect the accuracy of the lever test. However, researchers noted the presence of a meniscus tear led to a statistically significant difference in the accuracy of the lever test. The presence of a meniscus tear also led to decreased accuracy in the Lachman and anterior drawer tests, but led to no difference in the accuracy of the pivot shift test. – by Casey Tingle

Disclosures: McCulloch reports that he receives support from NIA Magellan, Genzyme, Slack, DePuy, Arthrex and Zimmer. Please see the full study for a list of all other authors’ relevant financial disclosures.