Display options
Cite
Jarbo KA, Hartigan DE, Scott KL, et al. Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries. Orthop J Sports Med. 2017;5(10):2325967117729809doi: 10.1177/2325967117729809.
Jarbo, K. A., Hartigan, D. E., Scott, K. L., Patel, K. A., & Chhabra, A. (2017). Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries. Orthopaedic journal of sports medicine, 5(10), 2325967117729809. https://doi.org/10.1177/2325967117729809
Jarbo, Keith A, et al. "Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries." Orthopaedic journal of sports medicine vol. 5,10 (2017): 2325967117729809. doi: https://doi.org/10.1177/2325967117729809
Jarbo KA, Hartigan DE, Scott KL, Patel KA, Chhabra A. Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries. Orthop J Sports Med. 2017 Oct 11;5(10):2325967117729809. doi: 10.1177/2325967117729809. eCollection 2017 Oct. PMID: 29051898; PMCID: PMC5639970.
Copy Download .nbib Format: NLM
Share it on

Orthop J Sports Med. 2017 Oct 11;5(10):2325967117729809. doi: 10.1177/2325967117729809. eCollection 2017 Oct.

Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries.

Orthopaedic journal of sports medicine

Keith A Jarbo, David E Hartigan, Kelly L Scott, Karan A Patel, Anikar Chhabra

Affiliations

  1. OrthoArizona, Phoenix, Arizona, USA.
  2. Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA.
  3. Arizona State University, Phoenix, Arizona, USA.

PMID: 29051898 PMCID: PMC5639970 DOI: 10.1177/2325967117729809

Abstract

BACKGROUND: The lever sign test is a new physical examination tool to diagnose anterior cruciate ligament (ACL) tears. Preliminary results suggest almost 100% sensitivity and specificity to diagnose acute and chronic complete ACL tears and clinically significant partial tears as compared with magnetic resonance imaging (MRI).

PURPOSE: To assess the sensitivity and specificity of the lever sign test for the diagnosis of acute ACL injuries, as compared to MRI. We also aimed to determine the accuracy of the lever sign test compared with 3 other tests (anterior drawer, Lachman, and pivot shift) when performed by providers of various training levels, and with the patient awake or under anesthesia.

STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2.

METHODS: We evaluated patients with a chief concern of acute (≤4 weeks) knee pain seen between October 2014 and January 2015, with a thorough history, physical examination, and standard radiographs. MRI was the reference standard; patients without an MRI evaluation were excluded. The 4 physical examination maneuvers were performed on each symptomatic knee during the initial clinic visit (for nonsurgical patients) or under anesthesia in the operating room (for surgical patients) by a randomly assigned undergraduate student, medical student, orthopaedic resident, or orthopaedic fellow. The senior author trained all staff to perform the lever sign test. Statistical analyses were performed.

RESULTS: Of 102 patients, 54 were surgical (28 female, 26 male), and 48 were nonsurgical (16 female, 32 male); the mean patient age was 23 years (range, 15-66 years). The overall accuracy of the lever sign test was 77% (63% sensitivity, 90% specificity); the accuracy was similar between patients under anesthesia and awake (77% vs 76%, respectively). There were no significant differences when comparing the sensitivity and specificity of the lever sign test with patients under anesthesia and awake (sensitivity: under anesthesia, 86%, and awake, 68% [

CONCLUSION: Our study results challenge the exceptional sensitivity and specificity values (both 100%) of the lever sign test, as reported by the original author of the test.

Keywords: ACL; Lelli; anterior cruciate ligament; lever sign test

Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

References

  1. J Fam Pract. 2003 Sep;52(9):689-94 - PubMed
  2. Acta Orthop Scand Suppl. 1981;191:1-32 - PubMed
  3. J Bone Joint Surg Am. 2010 Sep 1;92(11):2067-75 - PubMed
  4. Clin Orthop Relat Res. 1976 Jul-Aug;(118):63-9 - PubMed
  5. Br Med Bull. 2007;84:5-23 - PubMed
  6. Clin Orthop Relat Res. 2007 Jan;454:48-53 - PubMed
  7. J Orthop Sports Phys Ther. 2006 May;36(5):267-88 - PubMed
  8. Am J Sports Med. 1986 Jan-Feb;14(1):88-91 - PubMed
  9. Arch Bone Jt Surg. 2013 Dec;1(2):94-7 - PubMed
  10. Am J Sports Med. 2004 Mar;32(2):369-75 - PubMed
  11. J Bone Joint Surg Am. 1976 Mar;58(2):179-85 - PubMed
  12. J Bone Joint Surg Br. 1990 Sep;72(5):816-21 - PubMed
  13. Am J Knee Surg. 1997 Summer;10 (3):125-8 - PubMed
  14. J Bone Joint Surg Am. 1971 Oct;53(7):1257-70 - PubMed
  15. J Sports Med. 1975 Jul-Aug;3(4):152-8 - PubMed
  16. Arthroscopy. 2005 Jan;21(1):19-24 - PubMed
  17. Knee Surg Sports Traumatol Arthrosc. 2013 Aug;21(8):1895-903 - PubMed
  18. J Bone Joint Surg Br. 1995 Jul;77(4):586-8 - PubMed
  19. Clin Orthop Relat Res. 1995 Aug;(317):237-42 - PubMed
  20. J Bone Joint Surg Am. 1980 Mar;62(2):259-70 - PubMed
  21. Springerplus. 2015 Dec 30;4:830 - PubMed
  22. J Bone Joint Surg Am. 1979 Jul;61(5):710-4 - PubMed
  23. Am J Sports Med. 1995 Jan-Feb;23 (1):111-8 - PubMed
  24. Am J Sports Med. 1976 Mar-Apr;4(2):84-93 - PubMed
  25. Knee Surg Sports Traumatol Arthrosc. 2016 Sep;24(9):2794-7 - PubMed
  26. Arch Orthop Trauma Surg. 1986;106(1):5-7 - PubMed
  27. Am J Sports Med. 1985 Jan-Feb;13(1):5-10 - PubMed
  28. Acta Orthop Belg. 1986 Jul-Aug;52(4):479-87 - PubMed
  29. Am J Sports Med. 2008 Nov;36(11):2083-90 - PubMed
  30. Am J Sports Med. 2001 Sep-Oct;29(5):600-13 - PubMed
  31. J Bone Joint Surg Am. 1978 Dec;60(8):1015-30 - PubMed
  32. J Trauma. 2008 Nov;65(5):1078-82 - PubMed
  33. Clin Sports Med. 1999 Jan;18(1):109-71 - PubMed
  34. J Bone Joint Surg Am. 2009 Jan;91(1):198-208 - PubMed
  35. Radiology. 1988 Mar;166(3):861-4 - PubMed

Publication Types