title: The reliability of physical examination tests for the diagnosis of anterior cruciate ligament rupture--A systematic review.
abstract: METHODS
  Systematic literature review.
  
  
  BACKGROUND
  Despite their frequent application in routine care, a systematic review on the reliability of clinical examination tests to evaluate the integrity of the ACL is missing.
  
  
  OBJECTIVE
  To summarize and evaluate intra- and interrater reliability research on physical examination tests used for the diagnosis of ACL tears.
  
  
  METHODS
  A comprehensive systematic literature search was conducted in MEDLINE, EMBASE and AMED until May 30th 2013. Studies were included if they assessed the intra- and/or interrater reliability of physical examination tests for the integrity of the ACL. Methodological quality was evaluated with the Quality Appraisal of Reliability Studies (QAREL) tool by two independent reviewers.
  
  
  RESULTS
  110 hits were achieved of which seven articles finally met the inclusion criteria. These studies examined the reliability of four physical examination tests. Intrarater reliability was assessed in three studies and ranged from fair to almost perfect (Cohen's k = 0.22-1.00). Interrater reliability was assessed in all included studies and ranged from slight to almost perfect (Cohen's k = 0.02-0.81). The Lachman test is the physical tests with the highest intrarater reliability (Cohen's k = 1.00), the Lachman test performed in prone position the test with the highest interrater reliability (Cohen's k = 0.81). Included studies were partly of low methodological quality. A meta-analysis could not be performed due to the heterogeneity in study populations, reliability measures and methodological quality of included studies.
  
  
  CONCLUSIONS
  Systematic investigations on the reliability of physical examination tests to assess the integrity of the ACL are scarce and of varying methodological quality.
authors.affiliation: University Hospital Carl Gustav Carus Dresden, Center for Evidence-Based Healthcare, Fetscherstr. 74, 01307 Dresden, Germany.
authors.forename: Toni
authors.initials: T
authors.lastname: Lange
authors.affiliation: Technical University Dresden, Medical Faculty, Institute and Policlinic of Occupational and Social Medicine, Fetscherstr. 74, 01307 Dresden, Germany.
authors.forename: Alice
authors.initials: A
authors.lastname: Freiberg
authors.affiliation: Technical University Dresden, Medical Faculty, Institute and Policlinic of Occupational and Social Medicine, Fetscherstr. 74, 01307 Dresden, Germany.
authors.forename: Patrik
authors.initials: P
authors.lastname: Dröge
authors.affiliation: University Hospital Carl Gustav Carus Dresden, Centre for Orthopaedics and Trauma Surgery, Fetscherstr. 74, 01307 Dresden, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Lützner
authors.affiliation: University Hospital Carl Gustav Carus Dresden, Center for Evidence-Based Healthcare, Fetscherstr. 74, 01307 Dresden, Germany; Technical University Dresden, Medical Faculty, Institute and Policlinic of Occupational and Social Medicine, Fetscherstr. 74, 01307 Dresden, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.affiliation: University Hospital Carl Gustav Carus Dresden, Center for Evidence-Based Healthcare, Fetscherstr. 74, 01307 Dresden, Germany. Electronic address: Christian.Kopkow@uniklinikum-dresden.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Kopkow
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis* / Q000534:rehabilitation; D003955:Diagnostic Tests, Routine / Q000379:methods; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000175:diagnosis / Q000534:rehabilitation; D008297:Male; D010147:Pain Measurement; D010808:Physical Examination / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*; D015203:Reproducibility of Results; D063189:Symptom Assessment
keywords: Anterior cruciate ligament; Lachman test; Reliability; Systematic review