Evaluating Different Clinical Diagnosis of Anterior Cruciate Ligament Ruptures In Providers with Different Training...

Previous studies have shown that provider training and the tests performed play a role in the accuracy of diagnosis of anterior cruciate ligament (ACL) injuries. The specific aim of the current study is to determine the examiner proficiency and accuracy in performing the different proactive tests of ACL rupture before and after the induction of anesthesia prior to a definitive surgical procedure.

A case series was performed from January of 2015 through July of 2015. Two examiners were included (an experienced orthopaedic sports surgeon with more than 16 years in practice and an experienced orthopaedic physician assistant with 6 years of clinical experience in orthopaedic sports medicine). Three different physical examination tests were used before and after the induction of anesthesia to the patient: 1) Lachman test, 2) pivot shift test, and 3) Lelli test. Relevant patient demographic information such as BMI, thigh girth, and calf girth were recorded. Diagnosis of ACL rupture had been established pre-operatively.

Thirty three patients met the inclusion criteria (males: 21 (64%), female: 12 (36%)). High percent of false negative was found with pivot shift test for both before and after anesthesia when compared to the other two tests. The Lelli test seemed to be most favorable to both the surgeon and the physician assistant with at least 67% favorable, while the pivot shift was least often felt to be the most useful test. No relationship was found for either patients' thigh or patients' calf girths with the physical examination test results for both examiners for any of the three tests (p = 0.110).

The diagnostic accuracy and limitations of the various tests for ACL injury need to be understood. Clinically, it is recommended performing at least two different examinations, as each test has its own specific limitations. Level of Evidence: III- Prospective Cohort Study without blinding.