Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis.
OBJECTIVE
This systematic review summarizes the evidence on the accuracy of tests for assessing ACL ruptures of the knee.


METHODS
A computerized search of MEDLINE (1966-2003) and EMBASE (1980-2003) with additional reference tracking.


METHODS
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.


METHODS
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.


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.
Scholten
Rob J P M
RJ
Dutch Cochrane Centre, Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands. r.j.scholten@amc.uva.nl
Opstelten
Wim
W
van der Plas
Cees G
CG
Bijl
Dick
D
Deville
Walter L J M
WL
Bouter
Lex M
LM
D000070598:Anterior Cruciate Ligament Injuries; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis*; D010808:Physical Examination; D011237:Predictive Value of Tests; D012421:Rupture