Comparison of the Lever Sign, Lachman Test, and Lateral Pivot Shift Test for Assessing Diagnostic Accuracy in Complete Anterior Cruciate Ligament Tears: A Cross-sectional Study
Introduction: Clinical examination remains fundamental in diagnosing Anterior Cruciate Ligament (ACL) tears, with various tests available. The main tests include the anterior drawer test, Lachman test, and lateral pivot shift test. Lelli’s test (lever sign) is a relatively new clinical test for diag...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2025-05-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/20994/78127_CE[Ra1]_F(IS)_QC(PS_IS)_PF1(RI_IS)_redo_PFA(IS)_PB(RI_IS)_PN(IS).pdf |
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| Summary: | Introduction: Clinical examination remains fundamental in diagnosing Anterior Cruciate Ligament (ACL) tears, with various tests available. The main tests include the anterior drawer test, Lachman test, and lateral pivot shift test. Lelli’s test (lever sign) is a relatively new clinical test for diagnosing complete ACL tears. Each test shows variable sensitivity, specificity, and accuracy in different studies, and literature on the lever sign is limited.
Aim: To evaluate and compare the diagnostic accuracy of three clinical tests-the Lachman test, lever sign test, and lateral pivot shift test-in diagnosing complete ACL tears.
Materials and Methods: This analytical cross-sectional study was conducted at Government Medical College Palakkad and Government District Hospital, Palakkad, Kerala, India, from March 2024 to December 2024. A total of 61 patients with suspected ACL injuries underwent all three clinical tests, with results compared against Magnetic Resonance Imaging (MRI) and arthroscopic findings. The data were entered into a Microsoft Excel spreadsheet, and analysis was performed using the Statistical Package for Social Sciences (SPSS) Version 29.0. Sensitivity, specificity, and diagnostic accuracy were calculated for individual tests and their combinations. The agreement between clinical tests and the final diagnosis was assessed using Cohen’s kappa coefficient. A p-value of less than 0.05 was considered statistically significant.
Results: The study population had a mean age of 28.4±7.2 years. The study included 33 confirmed ACL tears and 28 cases without tears. The Lachman test showed high sensitivity (90.9%) but moderate specificity (67.9%). The lever sign demonstrated balanced sensitivity (84.8%) and specificity (85.7%). The lateral pivot shift test exhibited perfect specificity (100%) but lower sensitivity (45.5%). The combination of all three tests achieved the highest diagnostic accuracy (96.7%, p-value <0.001), significantly outperforming individual tests. The Lachman test showed great agreement (kappa coefficient 0.82), the lever sign showed substantial agreement (kappa coefficient 0.7), and the lateral pivot shift test showed low agreement (kappa coefficient 0.43) with the final diagnosis.
Conclusion: While each test has unique diagnostic strengths, the combination of all three tests provides optimal diagnostic accuracy. The present study supports a comprehensive clinical examination approach using the Lachman test, lever sign test, and lateral pivot shift test for accurate ACL tear diagnosis. |
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| ISSN: | 2249-782X 0973-709X |