Rupture of anterior cruciate ligaments and the Lever Test in diagnosis: a critical review
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Keywords

Ligament
Anterior cruciate ligament
ACL
Knee
Lever test

Abstract

Anterior Cruciate Ligament (ACL) rupture is known to be one of the most common musculoskeletal injuries in active individuals especially athletes. Approximately 200,000 ACL injuries occur every year, of which 100,000 require surgery. Once ruptured, it becomes very difficult to regain its previous function and it does not have the capacity to heal on its own. It is thus very important to diagnose an ACL rupture as early as possible. Clinicians need to perform a test which has a high sensitivity to rule out a negative test and specificity in order to rule in a positive test in the diagnosis. In this review four different tests (Lever Sign Test, Lachman Test, Anterior Drawer Test and Pivot Shift Test) are put to comparison and it is aimed to find the accuracy of the Lever Sign Test in diagnosing ruptured ACL as a diagnostic tool.

https://doi.org/10.48037/mbmj.v9i4.1407
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References

Smith MA, Smith WT, Kosko P. Anterior cruciate ligament tears: reconstruction and rehabilitation. Orthop Nurs 2014;33(1):14-24. Available from: https://doi.org/10.1097/NOR.0000000000000019

Meisterling SW, Schoderbek Jr RJ, Andrews JR. Anterior cruciate ligament reconstruction. Operative Techniques Sports med. 2009;17(1):2-10. Available from: https://doi.org/10.1053/j.otsm.2009.02.003

Rugg CM, Wang D, Sulzicki P, Hame SL. Effects of prior knee surgery on subsequent injury, imaging, and surgery in NCAA collegiate athletes. Am J Sports Med 2014:42(4):959-964. Available from: https://doi.org/10.1177/0363546513519951

Renstrom P, Ljungqvist A, Arendt E, et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 2008;42(6):394-412. Available from: https://doi.org/10.1136/bjsm.2008.048934

Messner K, Maletius W. Eighteen-to twenty-five-year follow-up after acute partial anterior cruciate ligament rupture. Am J Sports Med 1999;27(4):455-459. Available from: https://doi.org/10.1177/03635465990270040801

Filbay SR, Grevnerts HT, Sonesson S, Hedevik H, Kvist J. The Swedish version of the Anterior Cruciate Ligament Quality Of Life measure (ACL-QOL): translation and measurement properties. Qual Life Res 2023, 32(2):593-604. Available from: https://doi.org/10.1007/s11136-022-03265-1

Frobell R, Lohmander L, Roos H. Acute rotational trauma to the knee: poor agreement between clinical assessment and magnetic resonance imaging findings. Scan J Med Sci Sports 2007;17(2):109-114. Available from: https://doi.org/10.1111/j.1600-0838.2006.00559.x

Arnoczky S. Microvasculature of the cruciate ligaments and its response to injury. An experimental study in dogs. 82;64:217-224.

Lelli A, Di Turi RP, Spenciner DB, Dòmini M. The “Lever Sign”: a new clinical test for the diagnosis of anterior cruciate ligament rupture. Knee surg sports traumatol arthrosc 2016;24:2794-2797. Available from: https://doi.org/10.1007/s00167-014-3490-7

Zhao M, Zhou Y, Chang J, et al. The accuracy of MRI in the diagnosis of anterior cruciate ligament injury. Ann Transl Med 2020;8(24). Available from: https://doi.org/10.21037/atm-20-7391

Koo B, Lee SH, Yun SJ, Song JG. Diagnostic performance of magnetic resonance imaging for detecting meniscal ramp lesions in patients with anterior cruciate ligament tears: a systematic review and meta-analysis. Am J Sports Med 2020;48(8):2051-2059. Available from: https://doi.org/10.1177/0363546519880528

Logerstedt DS, Scalzitti D, Risberg MA, et al. Knee stability and movement coordination impairments: knee ligament sprain revision 2017. J Orthop Sports Phys Ther 2017;47(11):A1-A47. Available from: https://doi.org/10.2519/jospt.2017.0303

Van Der List JP, DiFelice GS. Role of tear location on outcomes of open primary repair of the anterior cruciate ligament: a systematic review of historical studies. Knee 2017;24(5):898-908. Available from: https://doi.org/10.1016/j.knee.2017.05.009

Brady MP, Weiss W. Clinical diagnostic tests versus MRI diagnosis of ACL tears. J Sports Rehab. 2018;27(6):596-600. Available from: https://doi.org/10.1123/jsr.2016-0188

Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 2006;36(5):267-288. Available from: https://doi.org/10.2519/jospt.2006.2011

Van Dyck P, Vanhoenacker FM, Lambrecht V, et al. Prospective comparison of 1.5 and 3.0-T MRI for evaluating the knee menisci and ACL. J Bone Joint Surg Am 2013;95(10):916-924. Available from: https://doi.org/10.2106/JBJS.L.01195

Lichtenberg MC, Koster CH, Teunissen LP, et al. Does the Lever sign test have added value for diagnosing anterior cruciate ligament ruptures? Orthop J Sports Med 2018;(3):2325967118759631. Available from: https://doi.org/10.1177/2325967118759631

Gürpınar T, Polat B, Polat AE, Çarkçı E, Öztürkmen Y. Diagnostic accuracy of Lever sign test in acute, chronic, and postreconstructive ACL injuries. BioMed Res Int 2019;20193639693. Available from: https://doi.org/10.1155/2019/3639693

Bilgin E, Turgut A, Hancıoğlu S, et al. The influence of anesthesia-body mass index and chronicity of the injury on the reliability of diagnostic tests for anterior cruciate ligament rupture. J Exerc Rehabil 2021;17(6):428. Available from: https://doi.org/10.12965/jer.2142580.290

Shair NA, Siddiq UA, Tariq A, Khalid M. Effectiveness of lever sign test for diagnosing anterior cruciate ligament rupture. Pak J Med Sci 2022;38(4Part-II):946. Available from: https://doi.org/10.12669/pjms.38.4.4993

Gans I, Retzky JS, Jones LC, Tanaka MJ: Epidemiology of recurrent anterior cruciate ligament injuries in National Collegiate Athletic Association sports: the Injury Surveillance Program, 2004-2014. Orthop J Sports Med 2018;6(6):2325967118777823. Available from: https://doi.org/10.1177/2325967118777823