Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Jing'an District, Shanghai, China.
Department of Orthopaedic Surgery, North Branch of Huashan Hospital Fudan University, 518th Jingpohu Road, Bao'shan District, Shanghai, China.
J Orthop Surg Res. 2021 Apr 14;16(1):260. doi: 10.1186/s13018-021-02381-x.
This study was aimed to utilize a modified anterior drawer test (MADT) to detect the anterior cruciate ligament (ACL) ruptures and investigate its accuracy compares with three traditional tests.
Four hundred patients were prospectively enrolled between January 2015 and September 2017 preoperatively to undergo knee arthroscopic surgeries. The MADT, anterior drawer test, Lachman test, and pivot shift test were used in the outpatient clinical setting and were compared statistically for their accuracy in terms of ACL ruptures, with arthroscopic findings as the gold standard.
The prevalence of ACL ruptures in this study was 37.0%. The MADT demonstrated the highest sensitivity (0.89) and accuracy (0.92) among the four tests and had comparable specificity (0.94) and a positive predictive value (0.90) compared with the anterior drawer test, Lachman test, and pivot shift test. The diagnostic odds ratio (DOR) of MADT was 122.92, with other test values of no more than 55.45. The area under the receiver operating characteristic curve (AUC) for the MADT was 0.92 ± 0.01, with a significant difference compared with that for the anterior drawer test (z = 17.00, p < 0.001), Lachman test (z = 9.66, p = 0.002), and pivot shift test (z = 16.39, p < 0.001). The interobserver reproducibility of the MADT was good, with a kappa coefficient of 0.86. When diagnosing partial tears of ACL, the MADT was significantly more sensitive than the anterior drawer test (p < 0.001), Lachman test (p = 0.026), and pivot shift test (p = 0.013). The MADT showed similar sensitivity in detecting anteromedial and posterolateral bundle tears (p = 0.113) and no difference in diagnosing acute and chronic ACL ruptures (χ = 1.682, p = 0.195).
The MADT is also an alternative diagnostic test to detect ACL tear, which is equally superior to the anterior drawer test, Lachman test, and pivot shifting test. It could improve the diagnosis of ACL ruptures combined with other clinical information including injury history, clinical examination, and radiological findings.
Level II/observational diagnostic studies TRIAL REGISTRATION: Chinese Clinical Trial Registry. ChiCTR1900022945 /retrospectively registered.
本研究旨在利用改良前抽屉试验（MADT）检测前交叉韧带（ACL）撕裂，并与三种传统试验进行比较，以评估其准确性。
2015 年 1 月至 2017 年 9 月期间，前瞻性纳入 400 例拟行膝关节镜手术的患者。在门诊临床环境中使用 MADT、前抽屉试验、Lachman 试验和枢轴转移试验，并以关节镜检查结果作为金标准，比较其在 ACL 撕裂方面的准确性。
本研究中 ACL 撕裂的患病率为 37.0%。MADT 在四项试验中的灵敏度（0.89）和准确性（0.92）最高，与前抽屉试验、Lachman 试验和枢轴转移试验相比，其特异性（0.94）和阳性预测值（0.90）相当。MADT 的诊断比值比（DOR）为 122.92，而其他试验的值均不超过 55.45。MADT 的受试者工作特征曲线（ROC）下面积（AUC）为 0.92±0.01，与前抽屉试验（z=17.00，p<0.001）、Lachman 试验（z=9.66，p=0.002）和枢轴转移试验（z=16.39，p<0.001）相比有显著差异。MADT 的观察者间可重复性良好，kappa 系数为 0.86。在诊断 ACL 部分撕裂时，MADT 的灵敏度明显高于前抽屉试验（p<0.001）、Lachman 试验（p=0.026）和枢轴转移试验（p=0.013）。MADT 在检测前内束和后外束撕裂时具有相似的灵敏度（p=0.113），在诊断急性和慢性 ACL 撕裂时无差异（χ=1.682，p=0.195）。
MADT 也是一种诊断 ACL 撕裂的替代方法，其与前抽屉试验、Lachman 试验和枢轴转移试验同样优越。结合病史、临床检查和影像学发现等其他临床信息，可提高 ACL 撕裂的诊断率。
II 级/观察性诊断研究。
中国临床试验注册中心。ChiCTR1900022945/前瞻性注册。
