杠杆征在检测前交叉韧带撕裂中的诊断准确性：一项系统评价和荟萃分析
DIAGNOSTIC ACCURACY OF THE LEVER SIGN IN DETECTING ANTERIOR CRUCIATE LIGAMENT TEARS: A SYSTEMATIC REVIEW AND META-ANALYSIS.
作者信息
Abruscato Kristin, Browning Kelsie, Deleandro Daniel, Menard Quinn, Wilhelm Mark, Hassen Amy
机构信息
Department of Physical Therapy, Walsh University, North Canton, OH, USA.
出版信息
Int J Sports Phys Ther. 2019 Feb;14(1):2-13.
BACKGROUND
The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments in the knee. With the prevalence of ACL tears increasing, there is a growing need for clinical tests to rule in and rule out a suspected tear. A new clinical test for detecting ACL tears has been introduced with preliminary studies showing promising results.
HYPOTHESIS/PURPOSE: To systematically review and analyze information from the current literature on the diagnostic accuracy of the Lever Sign test for the use of diagnosing anterior cruciate ligament (ACL) injuries in a clinical setting.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
A computerized search of PubMed, Cinahl, Scopus, and Proquest databases as well as a hand-search was completed on all available literature using keywords relating to the diagnostic accuracy of the Lever Sign Test. A quality assessment was performed on each article included in this review utilizing the Quality Assessment of Diagnostic Accuracy Studies (QUADAS).
RESULTS
Eight articles were included, with only three studies exhibiting high quality, however the study samples were heterogenous. Included studies indicated that the Lever Sign test is both sensitive and specific in diagnosing ACL tears. Pooled sensitivity and specificity were 0.77 and 0.90, respectively. The negative likelihood ratio is 0.22 and the positive likelihood ratio is 6.60.
CONCLUSION
The Lever Sign test is comparable to other clinical tests used in current practice to detect an ACL rupture. The pooled data from current available literature on the Lever Sign indicate that a positive or negative test should result in a moderate shift in post-test probability. This test may be used in addition to other tests to rule in and rule out the presence of an ACL rupture.
LEVEL OF EVIDENCE
2a- Systematic Review of Level 2 diagnostic studies.
背景
前交叉韧带（ACL）是膝关节中最常受伤的韧带之一。随着ACL撕裂的患病率不断增加，临床上越来越需要用于确诊和排除疑似撕裂的检查。一种用于检测ACL撕裂的新临床检查已被引入，初步研究显示出有前景的结果。
假设/目的：系统回顾和分析当前文献中有关杠杆征试验在临床环境中诊断前交叉韧带（ACL）损伤的诊断准确性的信息。
研究设计
系统回顾和荟萃分析。
方法
使用与杠杆征试验诊断准确性相关的关键词，对PubMed、Cinahl、Scopus和Proquest数据库进行计算机检索，并对所有可用文献进行手工检索。利用诊断准确性研究质量评估（QUADAS）对本综述中纳入的每篇文章进行质量评估。
结果
纳入了8篇文章，只有3项研究质量较高，但研究样本具有异质性。纳入的研究表明，杠杆征试验在诊断ACL撕裂方面既敏感又特异。合并敏感度和特异度分别为0.77和0.90。阴性似然比为0.22，阳性似然比为6.60。
结论
杠杆征试验与目前临床实践中用于检测ACL断裂的其他临床检查相当。目前关于杠杆征的现有文献中的汇总数据表明，阳性或阴性试验结果应会导致验后概率有适度变化。该检查可与其他检查一起用于确诊和排除ACL断裂的存在。
证据级别
2a - 对2级诊断研究的系统回顾。
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