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Clinical Summary

ACL injury: lever sign test markedly more sensitive than traditional tests

Takeaway

  • In a pilot study, use of the lever sign in the emergency department (ED) was much more sensitive for anterior cruciate ligament (ACL) injury than were traditional clinical tests.

Why this matters

  • Examining an acutely injured knee is difficult.
  • In ED, ACL injuries are frequently missed.
  • Untreated ACL injuries or delayed vs timely repair can result in adverse outcomes.
  • Some data indicate lever sign test outperforms anterior drawer and Lachman tests.
    • Proponents argue it provokes less patient guarding.
    • It does not depend on examiner strength.
    • It is easy to learn, perform, and interpret.
  • To authors’ knowledge, this is the first study of lever sign test in ED setting.

Key results

  • 8 had MRI-confirmed ACL injury.
  • Lever sign vs traditional tests:
    • Diagnostic accuracy: 95% vs 88%.
    • Sensitivity: 100% vs 40%.
    • Specificity: 94% vs 100%.

Study design

  • Prospective 9-month single-center study of patients aged 12-55 years presenting with acute knee injury (n=45).
  • Physicians received a half-hour of training in the lever sign test.
  • In first half of study, all patients underwent lever sign test (n=21); in second half, all underwent anterior drawer or Lachman tests (n=24).
  • Outcome: lever sign test performance, with MRI the gold standard.
  • Funding: None disclosed.

Limitations

  • Very small nonrandomized, nonblinded study.

References


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