title: The utility of clinical measures for the diagnosis of achilles tendon injuries: a systematic review with meta-analysis.
abstract: OBJECTIVE
  To summarize and evaluate the current diagnostic accuracy of clinical measures used to diagnose Achilles tendon injuries.
  
  
  METHODS
  A literature search of MEDLINE, CINAHL, and EMBASE databases was conducted with key words related to diagnostic accuracy and Achilles tendon injuries.
  
  
  METHODS
  Original research articles investigating Achilles tendon injuries against an acceptable reference standard were included.
  
  
  METHODS
  Three studies met the inclusion criteria. Quality assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. DerSimonian-Laird random-effects models were used to pool sensitivity (SN), specificity (SP), and diagnostic odds ratios with their 95% confidence intervals (CIs).
  
  
  RESULTS
  The SN and negative likelihood ratio (-LR) values for Achilles tendon rupture measures ranged from 0.73 (95% CI = 0.65, 0.81) and 0.30 (95% CI = 0.23, 0.40) to 0.96 (95% CI = 0.93, 0.99) and 0.04 (95% CI = 0.02, 0.10), respectively, whereas SP and positive likelihood ratio (+LR) values ranged from 0.85 (95% CI = 0.72, 0.98) and 6.29 (95% CI = 2.33, 19.96) to 0.93 (95% CI = 0.84, 1.00) and 13.71 (95% CI = 3.54, 51.24), respectively, with the highest SN and SP both reported in the calf-squeeze test. The SN and -LR values for Achilles tendinopathy measures ranged from 0.03 (95% CI = 0.00, 0.08) and 0.97 (95% CI = not reported) to 0.89 (95% CI = 0.75, 0.98) and 0.19 (95% CI = not reported), whereas SP and +LR values ranged from 0.58 (95% CI = 0.38, 0.77) and 2.12 (95% CI = not reported) to 1.00 (95% CI = 1.00, 1.00) and infinity, respectively, with the highest SN and SP reported for morning stiffness and palpation for crepitus. Pooled analyses demonstrated similar diagnostic properties in all 3 clinical measures (arc sign, palpation, and Royal London Hospital test), with SN and -LR ranging from 0.42 (95% CI = 0.23, 0.62) and 0.68 (95% CI = 0.50, 0.93), respectively, for the arc sign, to 0.64 (95% CI = 0.44, 0.81) and 0.48 (95% CI = 0.29, 0.80), respectively, for palpation. Pooled SP and +LR ranged from 0.81 (95% CI = 0.65, 0.91) and 3.15 (95% CI = 1.61, 6.18), respectively, for palpation, to 0.88 (95% CI = 0.74, 0.96) SP for the arc sign and 3.84 (95% CI = 1.69, 8.73) +LR for the Royal London Hospital test.
  
  
  CONCLUSIONS
  Most clinical measures for Achilles tendon injury have greater diagnostic than screening capability.
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Michael
authors.initials: M
authors.lastname: Reiman
authors.forename: Ciara
authors.initials: C
authors.lastname: Burgi
authors.forename: Eileen
authors.initials: E
authors.lastname: Strube
authors.forename: Kevin
authors.initials: K
authors.lastname: Prue
authors.forename: Keaton
authors.initials: K
authors.lastname: Ray
authors.forename: Amanda
authors.initials: A
authors.lastname: Elliott
authors.forename: Adam
authors.initials: A
authors.lastname: Goode
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D006801:Humans; D011785:Quality Assurance, Health Care; D012015:Reference Standards; D012680:Sensitivity and Specificity; D063189:Symptom Assessment / Q000379:methods / Q000592:standards; D013708:Tendon Injuries / Q000175:diagnosis*
keywords: diagnostic accuracy; sensitivity; specificity