Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: A meta-analysis

Abstract

Objective: This systematic review summarizes the evidence on the accuracy of tests for assessing ACL ruptures of the knee. Search strategy: A computerized search of MEDLINE (1966-2003) and EMBASE (1980-2003) with additional reference tracking. Selection criteria: Articles included were written in English, French, German, or Dutch, and addressed the accuracy of at least 1 physical diagnostic test for ACL rupture, using arthrotomy, arthroscopy, or magnetic resonance imaging as the gold standard. Data collection and analysis: Two reviewers independently selected studies, assessed the methodological quality, and abstracted data using a standardized protocol. We calculated sensitivity, specificity, and likelihood ratios for each test and summary estimates, when appropriate and possible. Main results: Seventeen studies met the inclusion criteria. None assessed the index test and reference test independently (with blinding), and all but 2 displayed verification bias. Study results were heterogeneous. The pivot shift test seems to have favorable positive predictive value, and the Lachman test has good negative predictive value. The anterior drawer test is of unproven value. Conclusions: Reliable data are rare regarding the accuracy of physical diagnostic tests for ACL ruptures, especially in a primary care setting. For the time being, history taking and physical examination, albeit of limited use, should be considered with individual patient demands to provide the basis for further evaluation.