title: Accuracy and reliability of anterior cruciate ligament clinical examination in a multidisciplinary sports medicine setting.
abstract: OBJECTIVE
  To investigate the accuracy and reliability of anterior cruciate ligament (ACL) clinical examination in a multidisciplinary sports medicine setting.
  
  
  METHODS
  Retrospective review of patient charting.
  
  
  METHODS
  Community-based multidisciplinary sports medicine clinic.
  
  
  METHODS
  One hundred twelve patients with surgically confirmed ACL tear.
  
  
  METHODS
  Review of therapist, physician, and orthopedic surgeon charting.
  
  
  METHODS
  Scoring for the anterior drawer, Lachman, and pivot shift tests completed during clinical examination. Coefficient of agreement (P(o)) was calculated for each assessment technique to determine the interrater reliability. Sensitivity of assessment was determined by comparing patient's arthroscopic surgical results against clinician's scoring.
  
  
  RESULTS
  On average, P(o) values indicated only moderate levels of interrater reliability (anterior drawer, x = 0.57; Lachman, x = 0.45; pivot shift, x = 0.53), with great variation observed between clinician's scoring for each assessment technique. Accuracy testing demonstrated that the Lachman test had the highest level of sensitivity when administered by orthopedic surgeons (x = 86%) and that sensitivity varied greatly among clinician groups and by assessment technique (range, 15%-87%).
  
  
  CONCLUSIONS
  In sports medicine, unreliable or inaccurate clinical examination confounds the clinician's ability to make informed decisions regarding appropriate patient referral and treatment interventions. Our results indicate that levels of accuracy and reliability for clinical examination of the ACL within a multidisciplinary sports medicine setting may be much lower than previously reported within the literature. Further research is needed to clarify whether a standardized approach to ACL clinical examination could enhance levels of accuracy and reliability among clinicians working in a multidisciplinary setting.
authors.affiliation: Department of Human Anatomy & Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada. peelerj@cc.umanitoba.ca
authors.forename: J
authors.initials: J
authors.lastname: Peeler
authors.forename: J
authors.initials: J
authors.lastname: Leiter
authors.forename: P
authors.initials: P
authors.lastname: MacDonald
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D000070598:Anterior Cruciate Ligament Injuries; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis*; D008875:Middle Aged; D009985:Orthopedics; D010348:Patient Care Team; D010808:Physical Examination; D026761:Physical Therapy Specialty; D011320:Primary Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors