在拉赫曼试验中评估翻译终点的可靠性和诊断准确性。
The reliability and diagnostic accuracy of assessing the translation endpoint during the lachman test.
作者信息
Mulligan Edward P, McGuffie Daniel Q, Coyner Katherine, Khazzam Michael
机构信息
Associate Professor, University of Texas Southwestern Medical Center, School of Health Professions, Department of Physical Therapy, Dallas, TX, USA.
Orthopedic Physical Therapy Resident, University of Texas Southwestern Medical Center, School of Health Professions, Department of Physical Therapy, Dallas, TX, USA.
出版信息
Int J Sports Phys Ther. 2015 Feb;10(1):52-61.
BACKGROUND
Interpretation of Lachman testing when evaluating the status of the anterior cruciate ligament (ACL) typically includes a numerical expression classifying the amount of translation (Grade I, II, III) in addition to a categorical modifier (Grade A [firm] or B [absent]) to describe the quality of the passive anterior tibial translation's endpoint. Most clinicians rely heavily on this tactile sensation and place value in this judgment in order to render their diagnostic decision; however, the reliability and accuracy of this endpoint assessment has not been well established in the literature.
PURPOSE
The purpose of this study was to determine the intertester reliability of endpoint classification during the passive anterior tibial translation of a standard Lachman test and evaluate the classification's ability to accurately predict the presence or absence of an ACL tear.
STUDY DESIGN
Prospective, blinded, diagnostic reliability and accuracy study.
METHODS
Forty-five consecutive patients with a complaint of knee pain were independently evaluated for the endpoint classification during a Lachman test by two physical therapists before any other diagnostic assessment. The 21 men and 24 women ranged in age from 20 to 64 years (mean +/- SD age, 40.7 +/- 14) and in acuity of knee injury from 30 to 365 days (mean +/- SD, 238 +/-157).
RESULTS
17 of the 45 patients had a torn ACL. The agreement between examiners on A versus B endpoint classification was 91% with a kappa coefficient of 0.72. In contrast, classification agreement based on the translational amount had an agreement of 65% with a weighted kappa coefficient of 0.52. The sensitivity of the endpoint grade alone was 0.81 with perfect specificity resulting in a positive likelihood ratio of 6.2 and a negative likelihood ratio of 0.19. The overall accuracy of the Lachman test using the endpoint assessment grade alone was 93% with a number needed to diagnose of 1.2.
CONCLUSIONS
Nominal endpoint classification (A or B) from a Lachman test is a reliable and accurate reflection of the status of the ACL. The true dichotomous nature of the test's interpretation (positive vs. negative) is well-served by the quality of the endpoint during passive anterior tibial translation.
LEVEL OF EVIDENCE
背景
在评估前交叉韧带（ACL）状态时，Lachman试验的解读通常包括一个表示移位量的数值分类（I级、II级、III级），以及一个用于描述被动胫骨前移终点质量的分类修饰词（A级[坚实]或B级[无]）。大多数临床医生严重依赖这种触觉感受并重视这一判断来做出诊断决策；然而，这种终点评估的可靠性和准确性在文献中尚未得到充分证实。
目的
本研究的目的是确定标准Lachman试验被动胫骨前移过程中终点分类的检查者间可靠性，并评估该分类准确预测ACL撕裂存在与否的能力。
研究设计
前瞻性、盲法、诊断可靠性和准确性研究。
方法
45例连续主诉膝关节疼痛的患者在进行任何其他诊断评估之前，由两名物理治疗师在Lachman试验期间独立评估终点分类。21名男性和24名女性，年龄在20至64岁之间（平均年龄±标准差，40.7±14岁），膝关节损伤的病程在30至365天之间（平均±标准差，238±157天）。
结果
45例患者中有17例ACL撕裂。检查者之间关于A与B终点分类的一致性为91%，kappa系数为0.72。相比之下，基于移位量的分类一致性为65%，加权kappa系数为0.52。仅终点分级的敏感性为0.81，特异性为100%，阳性似然比为6.2，阴性似然比为0.19。仅使用终点评估分级的Lachman试验的总体准确性为93%，诊断所需例数为1.2。
结论
Lachman试验的名义终点分类（A或B）是ACL状态的可靠且准确的反映。被动胫骨前移过程中终点的质量很好地体现了该试验解读的真正二分性质（阳性与阴性）。
证据水平
2级。
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