title: Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia.
abstract: OBJECTIVE
  The aims of this meta-analysis were to determine the sensitivity and specificity of the Lachman, pivot shift and anterior drawer test for acute complete ACL rupture in the office setting and under anaesthesia. It was hypothesized that the Lachman test is the most sensitive and the pivot shift test the most specific. Secondly, it was hypothesized that the sensitivity and specificity of all three exams increases when the examination is performed under anaesthesia.
  
  
  METHODS
  An electronic database search was performed using MEDLINE and EMBASE. All cross-sectional and cohort studies comparing one or more physical examination tests for diagnosing acute complete ACL rupture to an accepted reference standard such as arthroscopy, arthrotomy and MRI were included.
  
  
  RESULTS
  Twenty studies were identified and included. The overall sensitivity of the Lachman test was 0.81 and the specificity 0.81; with anaesthesia, the sensitivity was 0.91 and the specificity 0.78. For the anterior drawer test, the sensitivity was 0.38 and the specificity 0.81; with anaesthesia, the sensitivity was 0.63 and the specificity 0.91. The sensitivity of the pivot shift test was 0.28 and the specificity 0.81; with anaesthesia, the sensitivity was 0.73 and the specificity 0.98.
  
  
  CONCLUSIONS
  In the office setting, the Lachman test has the highest sensitivity for diagnosing an acute, complete ACL rupture, while all three tests had comparable specificity. When the examination was performed under anaesthesia, the Lachman test still obtained the highest sensitivity, but the pivot shift test was the most specific.
  
  
  METHODS
  Meta-analysis of diagnostic test accuracy, Level II.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufman building suite 1011, Pittsburgh, PA 15213, USA. vaneckcf@upmc.edu
authors.forename: Carola F
authors.initials: CF
authors.lastname: van Eck
authors.forename: Michel P J
authors.initials: MP
authors.lastname: van den Bekerom
authors.forename: Freddie H
authors.initials: FH
authors.lastname: Fu
authors.forename: Rudolf W
authors.initials: RW
authors.lastname: Poolman
authors.forename: Gino M M J
authors.initials: GM
authors.lastname: Kerkhoffs
mesh_terms: D000768:Anesthesia, General; D000070598:Anterior Cruciate Ligament Injuries; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis*; D010808:Physical Examination / Q000379:methods*; D011237:Predictive Value of Tests; D012421:Rupture; D012680:Sensitivity and Specificity