Abstract：
OBJECTIVE: Injuries of the anterior cruciate ligament (ACL) are common knee injuries among active and younger patients. The Lever Sign Test (LST) is a relatively newer test, of which the accuracy is disputed in the existing literature. The aim of this study was to assess the accuracy with and without anesthesia of the Lever Sign test in the literature.
METHODS: PRISMA guidelines were followed, studies were identified using PubMed, EMBASE and Google Scholar. All studies that reported accuracy of LST performed by a clinical professional were included. Integrity of ACL was confirmed using magnetic resonance imaging or arthroscopy. Sensitivity and specificity were calculated using uni- and bivariate methods.
RESULTS: After inclusion, 3299 observations in 2516 patients were included from 23 studies. Mean age was 31.8 years and 64.2% were male. Without anesthesia, sensitivity was 79.2% (95% CI 68.7-86.9) and specificity was 92.0% (95% CI 82.2-96.6). An area under the curve (AUC) of 86.1% was found. With anesthesia, sensitivity was 86.6% (95% CI 68.0-95.2), specificity was 93.4% (95% CI 84.5-97.3) and the AUC was 91.6%.
CONCLUSIONS: The Lever Sign test shows very good to excellent accuracy for ACL injury, and is a useful tool for clinical practice.
METHODS: PRISMA guidelines were followed, studies were identified using PubMed, EMBASE and Google Scholar. All studies that reported accuracy of LST performed by a clinical professional were included. Integrity of ACL was confirmed using magnetic resonance imaging or arthroscopy. Sensitivity and specificity were calculated using uni- and bivariate methods.
RESULTS: After inclusion, 3299 observations in 2516 patients were included from 23 studies. Mean age was 31.8 years and 64.2% were male. Without anesthesia, sensitivity was 79.2% (95% CI 68.7-86.9) and specificity was 92.0% (95% CI 82.2-96.6). An area under the curve (AUC) of 86.1% was found. With anesthesia, sensitivity was 86.6% (95% CI 68.0-95.2), specificity was 93.4% (95% CI 84.5-97.3) and the AUC was 91.6%.
CONCLUSIONS: The Lever Sign test shows very good to excellent accuracy for ACL injury, and is a useful tool for clinical practice.
摘要：
目的：前交叉韧带（ACL）损伤是活跃和年轻患者中常见的膝关节损伤。杠杆标志测试（LST）是一个相对较新的测试，其准确性在现有文献中存在争议。这项研究的目的是评估文献中杠杆符号测试有无麻醉的准确性。
方法：遵循PRISMA指南，研究是使用PubMed确定的，EMBASE和谷歌学者。包括所有报告由临床专业人员进行的LST准确性的研究。使用磁共振成像或关节镜检查确认ACL的完整性。使用单变量和双变量方法计算敏感性和特异性。
结果：纳入后，从23项研究中纳入了2516例患者的3299观察结果。平均年龄为31.8岁，男性占64.2%。没有麻醉,敏感性为79.2%(95%CI68.7~86.9),特异性为92.0%(95%CI82.2~96.6).发现曲线下面积(AUC)为86.1%。用麻醉,灵敏度为86.6%（95%CI68.0-95.2），特异性为93.4%(95%CI84.5-97.3),AUC为91.6%.
结论：杠杆符号测试表明ACL损伤的准确性非常好，是临床实践的有用工具。
方法：遵循PRISMA指南，研究是使用PubMed确定的，EMBASE和谷歌学者。包括所有报告由临床专业人员进行的LST准确性的研究。使用磁共振成像或关节镜检查确认ACL的完整性。使用单变量和双变量方法计算敏感性和特异性。
结果：纳入后，从23项研究中纳入了2516例患者的3299观察结果。平均年龄为31.8岁，男性占64.2%。没有麻醉,敏感性为79.2%(95%CI68.7~86.9),特异性为92.0%(95%CI82.2~96.6).发现曲线下面积(AUC)为86.1%。用麻醉,灵敏度为86.6%（95%CI68.0-95.2），特异性为93.4%(95%CI84.5-97.3),AUC为91.6%.
结论：杠杆符号测试表明ACL损伤的准确性非常好，是临床实践的有用工具。
