D Saragaglia, C Bucher, DLamy
(Grenoble)
shift and Lachman. The latter is the most commonly used test. The “lever sign” is a new clinical test that was first described by Lelli et al. in 2014. The primary objective of this study was to determine the sensitivity of the lever sign test in the clinical diagnosis of ACL tears in the primary care with acute knee injury. Primary care being the first point of contact between patients and the healthcare system (general practitioners in this study). The secondary objective was to calculate the positive predictive value (PPV) of the lever sign test, by comparing it to the PPV of the Lachman test and its sensitivity. The working hypothesis was that the sensitivity of the lever sign test was equal to or greater than 80%.
Methods: This prospective cohort study included patients with ski-related knee injuries which occurred in French ski resorts between December 1, 2019, and March 15, 2020. The Lachman test and the lever sign test were performed by 36 mountain physicians and the findings were compared with magnetic resonance imaging (MRI). The lever sign test involved placing a closed fist under the patient’s calf in the supine position and applying downward pressure over the quadriceps. Depending on whether the ACL was intact or not, the patient’s heel would either rise off the [examination] table or remain stationary. This study included 258 patients: 190 women and 68 men.
Results: The MRI found 219 ACL tears and 36 intact ACLs. Three MRIs were deemed uninterpretable. The sensitivity of the lever sign test was 61.2% and the PPV was 83.8%. The sensitivity of the Lachman test was 99.1% and the PPV was 86.5%.
Conclusion: The study determined the sensitivity of the lever sign test in the clinical diagnosis of ACL tears during real-life situations encountered by mountain physicians. This sensitivity was lower than expected. The Lachman test, on the other hand, showed a very high sensitivity. It remains the test of choice in the clinical diagnosis of ACL tears in patients with knee injuries. Therefore, the lever sign test can complement the Lachman test but is not a substitute for it.