›› 2017, Vol. 37 ›› Issue (11): 1513-.doi: 10.3969/j.issn.1674-8115.2017.11.011

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Evaluation of four physical examinations in diagnosis of complete rupture of anterior cruciate ligament

WU Yu-feng1*, CHEN Liang1*, GAO Da-wei1#, WANG Jin-wu2#   

  1. 1. Department of Orthopaedics, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan 528400,China; 2. Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2017-11-28 Published:2018-01-10
  • Supported by:
    National Basic Research Program of China, 2012CB933604; Joint Research Project of Shanghai Municipal Important Diseases, 2013ZYJB0501; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20152224; Key Developing Disciplines program of Shanghai Health System, 2015ZB04904; Clinical Research Plan of Shanghai Hospital Development Center, 16CR3088B; Industrialization Project of New Research and Development Institutions in Zhongshan Grant Support, 2016F2FC0019

Abstract: Objective · To estimate the value of four physical examination methods in the diagnosis of anterior cruciate ligament complete rupture.  Methods · A retrospective study was conducted on 100 patients who underwent surgical treatment for knee joint injury from July 11, 2016 to June 10, 2017. They received four physical examinations including Lachman test, anterior drawer test, lever sign test and pivot shift test. The results of the arthroscopy inspections were used as gold standard. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, accuracy and other parameter of four physical examinations were comprehensively discussed.  Results · Arthroscopic examination confirmed that 81 patients had complete rupture of anterior cruciate ligament. The sensitivities of anterior drawer test, lever test, pivot shift test and Lachman test were 87.7%, 100.0%, 97.5% and 96.3%, and the specificities were 84.2%, 78.9%, 73.7% and 63.2%, respectively. The positive predictive values were 95.9%, 95.3%, 94.0% and 91.8%, while the negative predictive values were 61.5%, 100.0%, 87.5% and 80.0%, respectively. The accuracies were 87%, 96%, 93% and 90%,  respectively. The positive likelihood ratios were 5.6, 4.7, 3.7 and 2.6, while the negative ones were 0.1, 0, 0 and 0.1, respectively.  Conclusion · Anterior drawer test is the most effective in diagnosing the complete rupture of the anterior cruciate ligament, while lever sign test is the most effective in excluding one. Lever sign test is the most sensitive and easy to operate, especially for fresh bruise, acute injury, limb swelling and obesity, with high diagnostic value.

Key words: anterior cruciate ligament rupture, physical examination, diagnosis, evaluation

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