School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada.
PLoS One. 2018 Jun 12;13(6):e0198797. doi: 10.1371/journal.pone.0198797. eCollection 2018.
To assess the diagnostic validity of clusters combining history elements and physical examination tests to diagnose partial or complete anterior cruciate ligament (ACL) tears.
Prospective diagnostic study.
Orthopaedic clinics (n = 2), family medicine clinics (n = 2) and community-dwelling.
Consecutive patients with a knee complaint (n = 279) and consulting one of the participating orthopaedic surgeons (n = 3) or sport medicine physicians (n = 2).
Not applicable.
History elements and physical examination tests performed independently were compared to the reference standard: an expert physicians' composite diagnosis including history elements, physical tests and confirmatory magnetic resonance imaging. Penalized logistic regression (LASSO) was used to identify history elements and physical examination tests associated with the diagnosis of ACL tear and recursive partitioning was used to develop diagnostic clusters. Diagnostic accuracy measures including sensitivity (Se), specificity (Sp), predictive values and positive and negative likelihood ratios (LR+/-) with associated 95% confidence intervals (CI) were calculated.
Forty-three individuals received a diagnosis of partial or complete ACL tear (15.4% of total cohort). The Lachman test alone was able to diagnose partial or complete ACL tears (LR+: 38.4; 95%CI: 16.0-92.5). Combining a history of trauma during a pivot with a "popping" sensation also reached a high diagnostic validity for partial or complete tears (LR+: 9.8; 95%CI: 5.6-17.3). Combining a history of trauma during a pivot, immediate effusion after trauma and a positive Lachman test was able to identify individuals with a complete ACL tear (LR+: 17.5; 95%CI: 9.8-31.5). Finally, combining a negative history of pivot or a negative popping sensation during trauma with a negative Lachman or pivot shift test was able to exclude both partial or complete ACL tears (LR-: 0.08; 95%CI: 0.03-0.24).
Diagnostic clusters combining history elements and physical examination tests can support the differential diagnosis of ACL tears compared to various knee disorders.
评估组合病史元素和体格检查测试以诊断部分或完全前交叉韧带（ACL）撕裂的诊断准确性。
前瞻性诊断研究。
骨科诊所（n=2）、家庭医学诊所（n=2）和社区。
连续就诊的膝关节不适患者（n=279），并咨询参与的骨科外科医生（n=3）或运动医学医生（n=2）之一。
不适用。
单独进行的病史元素和体格检查测试与参考标准进行比较：包括病史元素、物理检查和确认性磁共振成像的专家医生综合诊断。使用惩罚逻辑回归（LASSO）来识别与 ACL 撕裂诊断相关的病史元素和体格检查测试，并使用递归分区来开发诊断聚类。计算诊断准确性测量值，包括敏感性（Se）、特异性（Sp）、预测值以及阳性和阴性似然比（LR+/-）及其相关 95%置信区间（CI）。
43 人被诊断为部分或完全 ACL 撕裂（总队列的 15.4%）。单独的lachman 试验能够诊断部分或完全 ACL 撕裂（LR+：38.4；95%CI：16.0-92.5）。将创伤期间的 pivot 病史与“弹出”感相结合，也能达到较高的部分或完全撕裂的诊断准确性（LR+：9.8；95%CI：5.6-17.3）。将创伤期间的 pivot 病史、创伤后立即出现的积液和阳性 Lachman 试验相结合，能够识别出完全 ACL 撕裂的个体（LR+：17.5；95%CI：9.8-31.5）。最后，将 pivot 无创伤史或创伤期间无“弹出”感与阴性 Lachman 或 pivot shift 试验相结合，能够排除部分或完全 ACL 撕裂（LR-：0.08；95%CI：0.03-0.24）。
组合病史元素和体格检查测试的诊断聚类可支持与各种膝关节疾病相比，ACL 撕裂的鉴别诊断。
