title: Diagnostic accuracy of physical examination for anterior knee instability: a systematic review.
abstract: OBJECTIVE
  Determining diagnostic accuracy of Lachman, pivot shift and anterior drawer tests versus gold standard diagnosis (magnetic resonance imaging or arthroscopy) for anterior cruciate ligament (ACL) insufficiency cases. Secondarily, evaluating effects of: chronicity, partial rupture, awake versus anaesthetized evaluation.
  
  
  METHODS
  Searching MEDLINE, EMBASE and PubMed identified studies on diagnostic accuracy for ACL insufficiency. Studies identification and data extraction were performed in duplicate. Quality assessment used QUADAS tool, and statistical analyses were completed for pooled sensitivity and specificity.
  
  
  RESULTS
  Eight studies were included. Given insufficient data, pooled analysis was only possible for sensitivity on Lachman and pivot shift test. During awake evaluation, sensitivity for the Lachman test was 89 % (95 % CI 0.76, 0.98) for all rupture types, 96 % (95 % CI 0.90, 1.00) for complete ruptures and 68 % (95 % CI 0.25, 0.98) for partial ruptures. For pivot shift in awake evaluation, results were 79 % (95 % CI 0.63, 0.91) for all rupture types, 86 % (95 % CI 0.68, 0.99) for complete ruptures and 67 % (95 % CI 0.47, 0.83) for partial ruptures.
  
  
  CONCLUSIONS
  Decreased sensitivity of Lachman and pivot shift tests for partial rupture cases and for awake patients raised suspicions regarding the accuracy of these tests for diagnosis of ACL insufficiency. This may lead to further research aiming to improve the understanding of the true accuracy of these physical diagnostic tests and increase the reliability of clinical investigation for this pathology.
  
  
  METHODS
  IV.
authors.affiliation: Division of Orthopedic Surgery, Department of Surgery, McMaster University, 4E15- 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Leblanc
authors.affiliation: Division of Orthopedic Surgery, Department of Surgery, McMaster University, 4E15- 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalczuk
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Andruszkiewicz
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Simunovic
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.|Department of Surgery, McMaster University, Hamilton, ON, Canada.
authors.forename: Forough
authors.initials: F
authors.lastname: Farrokhyar
authors.affiliation: Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Travis Lee
authors.initials: TL
authors.lastname: Turnbull
authors.affiliation: Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Debski
authors.affiliation: Division of Orthopedic Surgery, Department of Surgery, McMaster University, 4E15- 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada. ayenif@mcmaster.ca.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ayenif@mcmaster.ca.
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000503:physiopathology; D007718:Knee Injuries / Q000175:diagnosis* / Q000503:physiopathology; D007719:Knee Joint / Q000503:physiopathology*; D010808:Physical Examination / Q000379:methods*; D012421:Rupture / Q000175:diagnosis
keywords: Anterior cruciate ligament; Diagnostic accuracy; Knee injuries; Physical examination; Rupture