title: Clinical examination of anterior cruciate ligament rupture: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the sensitivity and specificity of 3 tests for assessing anterior cruciate ligament (ACL) ruptures.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane Library, and CBM (Chinese Biomedical Literature Database) searches were performed. Studies selected for data extraction were those that addressed the accuracy of at least 1 physical diagnostic test for ACL rupture in comparison with a clinical reference standard such as arthroscopy, arthrotomy, or magnetic resonance imaging (MRI). The references of the included studies were also reviewed. Searches were limited to English and Chinese languages.
  
  
  RESULTS
  Sixteen studies that assessed the accuracy of the 3 tests for diagnosing ACL ruptures met the inclusion criteria. Study results were, however, heterogeneous. The Lachman test is the most sensitive test to determine ACL tears, showing a pooled sensitivity of 87.1% (95% confidence interval [CI] 0.84-0.90). The pivot shift test is the most specific test, showing a pooled specificity of 97.5% (95% CI 0.95-0.99); additionally, it has the highest positive likelihood ratios (LR+) of 16.00 (95% CI 7.34-34.87). The Lachman test has the lowest negative likelihood ratios (LR-) of 0.17 (95% CI 0.11-0.25).
  
  
  CONCLUSIONS
  In cases of suspected ACL injury, it is recommended to perform the pivot shift test, as it is highly specific and has greater likelihood and discrimination of accurately diagnosing ACL rupture. The Lachman test has great efficacy in ruling out a diagnosis of ACL rupture because of the lowest negative likelihood ratios.
authors: Graduate School of Southern Medical University, Guangzhou, China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China. luck_2001@126.com.
authors: Wenhan
authors: W
authors: Huang
authors: Graduate School of Southern Medical University, Guangzhou, China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors: Yu
authors: Y
authors: Zhang
authors: Graduate School of Southern Medical University, Guangzhou, China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors: Zilong
authors: Z
authors: Yao
authors: Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors: Linmin
authors: L
authors: Ma
mesh_terms: D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging*; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis*; D001182:Arthroscopy / Q000379:methods; D057186:Comparative Effectiveness Research; D061827:Dimensional Measurement Accuracy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D012680:Sensitivity and Specificity