杠杆征诊断前交叉韧带撕裂的准确性：一项Meta分析的系统评价
ACCURACY OF THE LEVER SIGN TO DIAGNOSE ANTERIOR CRUCIATE LIGAMENT TEAR: A SYSTEMATIC REVIEW WITH META-ANALYSIS.
作者信息
Reiman Michael P, Reiman Carly K, Décary Simon
机构信息
Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA.
Université Laval, Faculty of Medicine, Québec, Canada.
出版信息
Int J Sports Phys Ther. 2018 Aug;13(5):774-788.
BACKGROUND
The Lever sign has gained recent notoriety for its purported anterior cruciate ligament (ACL) diagnostics and simplicity of performance.
PURPOSE
The purpose of this systematic review with meta-analysis is to summarize the diagnostic accuracy of the Lever sign for use during assessment of the knee for an ACL tear in subjects with suspected acute and chronic knee injury.
STUDY DESIGN
Systematic review with meta-analysis.
METHODS
A computer-assisted literature search of MEDLINE, CINAHL, and EMBASE databases using keywords related to diagnostic accuracy of the knee joint. The (PRISMA) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies (QUADAS). Mixed effects models were used to summarize accuracy.
RESULTS
Eight articles, with only two demonstrating high quality, were included. Six of the articles were included in a meta-analysis. Diagnostic values, utilizing arthroscopy as a gold standard, were: pooled SN 0.55 (95% CI 0.22 to 0.84), pooled SP 0.89 (95% CI 0.44 to 0.99), positive likelihood ratio (+LR) 9.2 (95% CI 0.70 to 46.1), negative likelihood ratio (-LR) 0.58 (95% CI 0.18 to 1.28). Post-test probability with a positive finding (57% sampling prevalence) reached 92% (95% CI 83 to 97%). Post-test probability with a negative finding (57% sampling prevalence) reached 43% (95% CI 39 to 47%).
CONCLUSIONS
Based on limited evidence of heterogeneous methodological quality, the Lever sign can moderately change post-test probability to rule in an ACL tear. These results should be interpreted cautiously due to a limited number of studies, with small sample sizes and study quality affecting test accuracy. Future investigation should be expanded to include additional high-quality studies examining diverse clinical contexts, as they become available, to enable a more comprehensive clinical examination of this test.
LEVEL OF EVIDENCE
3aPROSPERO Registration # CRD42018084954.
背景
杠杆征因其在诊断前交叉韧带（ACL）损伤方面的作用及其操作简便性，近来声名远扬。
目的
本系统评价及荟萃分析旨在总结杠杆征在疑似急慢性膝关节损伤患者膝关节评估中诊断ACL撕裂的诊断准确性。
研究设计
系统评价及荟萃分析。
方法
使用与膝关节诊断准确性相关的关键词，对MEDLINE、CINAHL和EMBASE数据库进行计算机辅助文献检索。研究的检索和报告阶段采用系统评价和荟萃分析的首选报告项目（PRISMA）指南。使用诊断准确性研究质量（QUADAS）工具对偏倚和适用性进行质量评估。采用混合效应模型总结准确性。
结果
纳入8篇文章，其中仅有2篇质量较高。6篇文章纳入荟萃分析。以关节镜检查为金标准，诊断价值为：合并敏感度（SN）0.55（95%可信区间0.22至0.84），合并特异度（SP）0.89（95%可信区间0.44至0.99），阳性似然比（+LR）9.2（95%可信区间0.70至46.1），阴性似然比（-LR）0.58（95%可信区间0.18至1.28）。阳性结果的验后概率（抽样患病率57%）达到92%（95%可信区间83%至97%）。阴性结果的验后概率（抽样患病率57%）达到43%（95%可信区间39%至47%）。
结论
基于方法学质量参差不齐的有限证据，杠杆征可适度改变验后概率以确诊ACL撕裂。由于研究数量有限、样本量小且研究质量影响检测准确性，这些结果应谨慎解读。未来研究应扩大范围，纳入更多高质量研究，在有条件时考察不同临床背景，以便对该检测进行更全面的临床评估。
证据水平
3a
PROSPERO注册号：CRD42018084954
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