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Comparative Study
. 2017:37:71-79.

Evaluating Different Clinical Diagnosis of Anterior Cruciate Ligament Ruptures In Providers with Different Training Backgrounds

Alexander Cm Chong  1   2 , Chelsea Whitetree  3 , Michael C Priddy  2 , Parker R Zimmerman  2 , Paul R Haeder  2 , Daniel J Prohaska  2   3
Affiliations
Comparative Study

Evaluating Different Clinical Diagnosis of Anterior Cruciate Ligament Ruptures In Providers with Different Training Backgrounds

Alexander Cm Chong et al. Iowa Orthop J. 2017.

Abstract

Introduction: Previous studies have shown that provider training and the tests performed play a role in the accuracy of diagnosis of anterior cruciate ligament (ACL) injuries. The specific aim of the current study is to determine the examiner proficiency and accuracy in performing the different proactive tests of ACL rupture before and after the induction of anesthesia prior to a definitive surgical procedure.

Materials and methods: A case series was performed from January of 2015 through July of 2015. Two examiners were included (an experienced orthopaedic sports surgeon with more than 16 years in practice and an experienced orthopaedic physician assistant with 6 years of clinical experience in orthopaedic sports medicine). Three different physical examination tests were used before and after the induction of anesthesia to the patient: 1) Lachman test, 2) pivot shift test, and 3) Lelli test. Relevant patient demographic information such as BMI, thigh girth, and calf girth were recorded. Diagnosis of ACL rupture had been established pre-operatively.

Results: Thirty three patients met the inclusion criteria (males: 21 (64%), female: 12 (36%)). High percent of false negative was found with pivot shift test for both before and after anesthesia when compared to the other two tests. The Lelli test seemed to be most favorable to both the surgeon and the physician assistant with at least 67% favorable, while the pivot shift was least often felt to be the most useful test. No relationship was found for either patients' thigh or patients' calf girths with the physical examination test results for both examiners for any of the three tests (p = 0.110).

Conclusion: The diagnostic accuracy and limitations of the various tests for ACL injury need to be understood. Clinically, it is recommended performing at least two different examinations, as each test has its own specific limitations. Level of Evidence: III- Prospective Cohort Study without blinding.

Keywords: Anterior Cruciate Ligament; Arthroscopic Surgery; Lachman Test; Lelli Test; Pivot Shift Test.

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Conflict of interest statement

Conflict of Interest Statement: This study did not receive any funding support for this research. The participants and authors of this study did not receive any payments or other personal benefit, or commitments or agreements that were related in any way to the subject of the research that was conducted. No benefits of any form have been received directly or indirectly to the subject of this article. The authors report no actual or potential conflict of interest in relation to this article.

Figures

Figure 1
Figure 1
Physical Examination Test Performed. (a) Lachman Test, (b) Pivot Shift Test, and (c) Lelli Test
Figure 2
Figure 2
Validity For All Three Physical Examination ACL Tests Judgment of Negative Test
Figure 3
Figure 3
Examiners Preferred ACL Diagnostic Test
See this image and copyright information in PMC

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