Department of Physical Education, School of Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China.
Department of Arts and Design, School of Education and Arts, Shandong Institute of Petroleum and Chemical Technology, Dongying, China.
Medicine (Baltimore). 2022 Aug 5;101(31):e29263. doi: 10.1097/MD.0000000000029263.
This study compared 4 clinical tests with reference to magnetic resonance imaging and arthroscopic visualization to comprehensively evaluate their diagnostic value for anterior cruciate ligament injuries.
We systematically searched 10 electronic databases from January 1, 2010, to May 1, 2021. Two reviewers collected data in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analyses 2020 guidelines. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A meta-analysis was performed using Meta-Disc version 1.4 and Stata SE version 15.0.
Eighteen articles involving 2031 participants were included. The results of the meta-analysis showed that for the Lachman test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, area under the curve (AUC) of summary receiver operating characteristic (SROC), and Q* were 0.76 (95% CI, 0.73-0.78), 0.89 (95% CI, 0.87-0.91), 5.65 (95% CI, 4.05-7.86), 0.28 (95% CI, 0.23-0.36), 22.95 (95% CI, 14.34-36.72), 0.88, and 0.81, respectively. For the anterior drawer test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.64 (95% CI, 0.61-0.68), 0.87 (95% CI, 0.84-0.90), 3.57 (95% CI, 2.13-5.96), 0.44 (95% CI, 0.32-0.59), 8.77 (95% CI, 4.11-18.74), 0.85, and 0.78, respectively. For the pivot shift test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.59 (95% CI, 0.56-0.62), 0.97 (95% CI, 0.95-0.98), 13.99 (95% CI, 9.96-19.64), 0.44 (95% CI, 0.35-0.55), 29.46 (95% CI, 15.60-55.67), 0.98, and 0.94, respectively. For the lever sign test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.79 (95% CI, 0.75-0.83), 0.92 (95% CI, 0.87-0.95), 9.56 (95% CI, 2.76-33.17), 0.23 (95% CI, 0.12-0.46), 47.38 (95% CI, 8.68-258.70), 0.94, and 0.87, respectively.
Existing evidence shows that these clinical tests have high diagnostic efficacy for anterior cruciate ligament injuries, and that every test has its own advantages and disadvantages. However, the above results should be validated through additional studies, considering the limited quality and quantity of our sample.
本研究通过与磁共振成像和关节镜可视化比较，对 4 种临床检查全面评估其对前交叉韧带损伤的诊断价值。
我们系统检索了 2010 年 1 月 1 日至 2021 年 5 月 1 日的 10 个电子数据库。两名审查员根据系统评价和荟萃分析 2020 指南收集数据。使用诊断准确性研究质量评估工具 2 评估每个研究的质量。使用 Meta-Disc 版本 1.4 和 Stata SE 版本 15.0 进行荟萃分析。
纳入了 18 篇涉及 2031 名参与者的文章。荟萃分析的结果表明，对于 Lachman 试验，汇总的敏感性、特异性、阳性似然比、阴性似然比、诊断优势比、汇总受试者工作特征曲线（SROC）的曲线下面积（AUC）、Q分别为 0.76（95%置信区间，0.73-0.78）、0.89（95%置信区间，0.87-0.91）、5.65（95%置信区间，4.05-7.86）、0.28（95%置信区间，0.23-0.36）、22.95（95%置信区间，14.34-36.72）、0.88 和 0.81。对于前抽屉试验，汇总的敏感性、特异性、阳性似然比、阴性似然比、诊断优势比、SROC 的 AUC 和 Q分别为 0.64（95%置信区间，0.61-0.68）、0.87（95%置信区间，0.84-0.90）、3.57（95%置信区间，2.13-5.96）、0.44（95%置信区间，0.32-0.59）、8.77（95%置信区间，4.11-18.74）、0.85 和 0.78。对于枢轴转移试验，汇总的敏感性、特异性、阳性似然比、阴性似然比、诊断优势比、SROC 的 AUC 和 Q分别为 0.59（95%置信区间，0.56-0.62）、0.97（95%置信区间，0.95-0.98）、13.99（95%置信区间，9.96-19.64）、0.44（95%置信区间，0.35-0.55）、29.46（95%置信区间，15.60-55.67）、0.98 和 0.94。对于杠杆试验，汇总的敏感性、特异性、阳性似然比、阴性似然比、诊断优势比、SROC 的 AUC 和 Q分别为 0.79（95%置信区间，0.75-0.83）、0.92（95%置信区间，0.87-0.95）、9.56（95%置信区间，2.76-33.17）、0.23（95%置信区间，0.12-0.46）、47.38（95%置信区间，8.68-258.70）、0.94 和 0.87。
现有证据表明，这些临床检查对前交叉韧带损伤具有较高的诊断效能，且每种检查都有其自身的优缺点。但是，考虑到样本数量和质量有限，需要通过更多的研究来验证上述结果。
