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
References