Leblanc Marie-Claude, Kowalczuk Marcin, Andruszkiewicz Nicole, Simunovic Nicole, Farrokhyar Forough, Turnbull Travis Lee, Debski Richard E, Ayeni Olufemi R
Division of Orthopedic Surgery, Department of Surgery, McMaster University, 4E15- 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10):2805-13. doi: 10.1007/s00167-015-3563-2. Epub 2015 Mar 13.
Determining diagnostic accuracy of Lachman, pivot shift and anterior drawer tests versus gold standard diagnosis (magnetic resonance imaging or arthroscopy) for anterior cruciate ligament (ACL) insufficiency cases. Secondarily, evaluating effects of: chronicity, partial rupture, awake versus anaesthetized evaluation.
Searching MEDLINE, EMBASE and PubMed identified studies on diagnostic accuracy for ACL insufficiency. Studies identification and data extraction were performed in duplicate. Quality assessment used QUADAS tool, and statistical analyses were completed for pooled sensitivity and specificity.
Eight studies were included. Given insufficient data, pooled analysis was only possible for sensitivity on Lachman and pivot shift test. During awake evaluation, sensitivity for the Lachman test was 89 % (95 % CI 0.76, 0.98) for all rupture types, 96 % (95 % CI 0.90, 1.00) for complete ruptures and 68 % (95 % CI 0.25, 0.98) for partial ruptures. For pivot shift in awake evaluation, results were 79 % (95 % CI 0.63, 0.91) for all rupture types, 86 % (95 % CI 0.68, 0.99) for complete ruptures and 67 % (95 % CI 0.47, 0.83) for partial ruptures.
Decreased sensitivity of Lachman and pivot shift tests for partial rupture cases and for awake patients raised suspicions regarding the accuracy of these tests for diagnosis of ACL insufficiency. This may lead to further research aiming to improve the understanding of the true accuracy of these physical diagnostic tests and increase the reliability of clinical investigation for this pathology.
IV.
确定拉赫曼试验、轴移试验和前抽屉试验相对于前交叉韧带（ACL）功能不全病例的金标准诊断（磁共振成像或关节镜检查）的诊断准确性。其次，评估慢性、部分撕裂、清醒与麻醉评估的影响。
检索MEDLINE、EMBASE和PubMed以确定关于ACL功能不全诊断准确性的研究。研究识别和数据提取由两人独立进行。质量评估使用QUADAS工具，并对合并敏感性和特异性进行统计分析。
纳入八项研究。由于数据不足，仅能对拉赫曼试验和轴移试验的敏感性进行合并分析。在清醒评估期间，拉赫曼试验对所有撕裂类型的敏感性为89%（95%CI 0.76，0.98），对完全撕裂为96%（95%CI 0.90，1.00），对部分撕裂为68%（95%CI 0.25，0.98）。对于清醒评估中的轴移试验，所有撕裂类型的结果为79%（95%CI 0.63，0.91），完全撕裂为86%（95%CI 0.68，0.99），部分撕裂为67%（95%CI 0.47，0.83）。
拉赫曼试验和轴移试验对部分撕裂病例和清醒患者的敏感性降低，引发了对这些试验诊断ACL功能不全准确性的怀疑。这可能会促使进一步研究，旨在更好地理解这些体格诊断试验的真正准确性，并提高对此类病理临床研究的可靠性。
IV级
