TY - JOUR
T1 - Lever sign test shows high diagnostic accuracy for anterior cruciate ligament injuries
T2 - A systematic review and meta-analysis of 3299 observations
AU - Hesmerg, Mees K.
AU - Oostenbroek, Maurits H.W.
AU - van der List, Jelle P.
N1 - Publisher Copyright: © 2024 Elsevier B.V.
PY - 2024/3
Y1 - 2024/3
N2 - Purpose: Injuries of the anterior cruciate ligament (ACL) are common knee injuries among active and younger patients. The Lever Sign Test (LST) is a relatively newer test, of which the accuracy is disputed in the existing literature. The aim of this study was to assess the accuracy with and without anesthesia of the Lever Sign test in the literature. Methods: PRISMA guidelines were followed, studies were identified using PubMed, EMBASE and Google Scholar. All studies that reported accuracy of LST performed by a clinical professional were included. Integrity of ACL was confirmed using magnetic resonance imaging or arthroscopy. Sensitivity and specificity were calculated using uni- and bivariate methods. Results: After inclusion, 3299 observations in 2516 patients were included from 23 studies. Mean age was 31.8 years and 64.2% were male. Without anesthesia, sensitivity was 79.2% (95% CI 68.7–86.9) and specificity was 92.0% (95% CI 82.2–96.6). An area under the curve (AUC) of 86.1% was found. With anesthesia, sensitivity was 86.6% (95% CI 68.0–95.2), specificity was 93.4% (95% CI 84.5–97.3) and the AUC was 91.6%. Conclusion: The Lever Sign test shows very good to excellent accuracy for ACL injury, and is a useful tool for clinical practice.
AB - Purpose: Injuries of the anterior cruciate ligament (ACL) are common knee injuries among active and younger patients. The Lever Sign Test (LST) is a relatively newer test, of which the accuracy is disputed in the existing literature. The aim of this study was to assess the accuracy with and without anesthesia of the Lever Sign test in the literature. Methods: PRISMA guidelines were followed, studies were identified using PubMed, EMBASE and Google Scholar. All studies that reported accuracy of LST performed by a clinical professional were included. Integrity of ACL was confirmed using magnetic resonance imaging or arthroscopy. Sensitivity and specificity were calculated using uni- and bivariate methods. Results: After inclusion, 3299 observations in 2516 patients were included from 23 studies. Mean age was 31.8 years and 64.2% were male. Without anesthesia, sensitivity was 79.2% (95% CI 68.7–86.9) and specificity was 92.0% (95% CI 82.2–96.6). An area under the curve (AUC) of 86.1% was found. With anesthesia, sensitivity was 86.6% (95% CI 68.0–95.2), specificity was 93.4% (95% CI 84.5–97.3) and the AUC was 91.6%. Conclusion: The Lever Sign test shows very good to excellent accuracy for ACL injury, and is a useful tool for clinical practice.
KW - Anterior Cruciate Ligament (ACL)
KW - Clinical test
KW - Diagnostic accuracy
KW - Lelli test
KW - Lever Sign test
UR - http://www.scopus.com/inward/record.url?scp=85184504151&partnerID=8YFLogxK
U2 - 10.1016/j.knee.2024.01.003
DO - 10.1016/j.knee.2024.01.003
M3 - Review article
C2 - 38310817
SN - 0968-0160
VL - 47
SP - 81
EP - 91
JO - KNEE
JF - KNEE
ER -