Is the Lever Sign an Effective Diagnostic Tool for Acute Anterior Cruciate Ligament Tears: A Critically Appraised Topic
Date
2-14-2024
Faculty Mentor
David Kean, Kinesiology
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Submission Type
Conference Proceeding
Location
10:45-10:55am | Houston Cole Library, 11th Floor
Description
Context: The anterior cruciate ligament (ACL) is one of the most injured structures of the knee, occurring in 68.6 per 100,000 athletes per year. Assessing ACL injuries should be completed quickly and precisely to allow for appropriate injury management decisions. Special tests allow for expedited injury assessments by utilizing manual maneuvers that test the integrity of the ACL. Prevalent ACL special tests include the Lachman, Anterior Drawer, and Pivot Shift tests. These special tests require quick translational or rotational movements that can lead to patient apprehension and, thus, possible reduction of test accuracy. The Lever Sign is a special test that proposes to not be limited by patient factors such as pain, swelling, and apprehension.
Methods: A computerized search was completed in October 2023. The search terms used were acute ACL injuries, Lever Sign, Lachman, Anterior Drawer, and Pivot Shift. Electronic databases used were PubMed, EBSCOHOST, and Google Scholar. Inclusion criteria required articles to be written in the English language, published within the last ten years, peer-reviewed, contain all of the search words, and be predominantly focused on acute ACL injuries. Exclusion criteria included articles that focused solely on chronic ACL tears, ACL injuries with co-existing ligamentous or soft-tissue injuries, and any topics unrelated to the search terms provided. Validity of the selected cohort studies was determined using the STROBE checklist. One author independently reviewed the studies, scored each paper, and reviewed the completed appraisals to come to a consensus on the study quality.
Results: The literature search retrieved 224 total articles and 220 were excluded based on the exclusion criteria, resulting in four studies. The studies ranged from 61.2%-100% for sensitivity and 90% for specificity of the Lever sign. The average accuracy of the Lever sign from these four studies was 82.5%.
Conclusions: Each of these cohort studies had varying methodologies, hypotheses, and study parameters, but all had a common goal in determining the overall accuracy of the Lever Sign. It was determined from these studies that, with an average accuracy of 82.5%, the Lever Sign is a viable option for ACL diagnostic testing. However, due to inaccuracies between studies, the Lever Sign should not be performed as the sole diagnostic test in a physical examination, but should be completed in conjunction with other special tests. The Lever Sign was determined to be unaffected by patient factors, anesthesia, stage of injury, patient gender, and clinical experience level. Since the test has an easy learning curb, it allows clinicians to perform accurately with minimal training. Given these strengths, the Lever Sign could be an important tool for athletic trainers and other clinicians.
Keywords
student research, kinesiology
Rights
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Disciplines
Kinesiotherapy
Recommended Citation
Hopkins, Cody, "Is the Lever Sign an Effective Diagnostic Tool for Acute Anterior Cruciate Ligament Tears: A Critically Appraised Topic" (2024). JSU Student Symposium 2024. 28.
https://digitalcommons.jsu.edu/ce_jsustudentsymp_2024/28