Diagnostic Accuracy of Lever Sign Test in Acute, Chronic, and Postreconstructive ACL Injuries.

Current clinical methods for diagnosing anterior cruciate ligament (ACL) injuries rely on physical examination tests and imaging. While MRI remains the gold standard, clinicians often use physical tests like Lachman, anterior drawer, and pivot shift to assess ACL integrity. These tests vary in sensitivity and specificity, especially in different injury phases. Lever sign test has been proposed as a potential diagnostic tool but lacks comprehensive evaluation across acute, chronic, and postreconstructive stages. Prior research has shown that no single test provides perfect accuracy, and gaps remain in understanding how these tests perform in postoperative patients. This uncertainty drives the need for a systematic comparison of diagnostic accuracy across these phases. No prior work has resolved how lever sign test performs relative to established methods in all injury stages. This gap motivated the current study to assess lever sign's diagnostic value in a clinical setting.

This study aimed to evaluate the diagnostic accuracy of the lever sign test in patients with suspected ACL injuries. The specific problem addressed is the lack of consensus on the best clinical test for diagnosing ACL integrity across different injury phases. The motivation stems from the need for a reliable, reproducible test that can be used in acute, chronic, and postreconstructive settings. The authors sought to compare lever sign test with Lachman, anterior drawer, and pivot shift tests using MRI as the reference standard. By analyzing sensitivity, specificity, and area under the curve (AUC) values, the study aimed to determine if lever sign test could serve as a more accurate alternative. The goal was to provide clinicians with evidence-based guidance on the most effective diagnostic approach. This work contributes to the ongoing effort to improve physical examination accuracy in ACL assessment.

The study involved 78 patients with suspected ACL injuries, including both acute and chronic cases as well as postreconstructive patients. Clinical tests were performed bilaterally by two senior orthopaedic surgeons. The lever sign, Lachman, anterior drawer, and pivot shift tests were conducted in each patient. MRI scans were obtained for all participants and used as the reference standard for diagnostic accuracy. The tests were evaluated in three distinct phases: acute, chronic (preanaesthesia), and postreconstructive. Statistical analysis focused on sensitivity, specificity, and AUC values for each test. The mean age of participants was 26.2 years, with a range from 17 to 44 years. Data collection occurred during routine clinical assessments, ensuring real-world applicability of the findings.

The lever sign test demonstrated the highest sensitivity and accuracy in the acute phase, with values of 91.9% and 92.3%, respectively. Lachman test showed 80.6% sensitivity and 76.9% accuracy in the same phase. In the chronic phase, lever sign maintained high accuracy at 91.9% sensitivity and 92.3% accuracy. Lachman test performed slightly better at 83.9% sensitivity and 80.8% accuracy. The AUC values indicated strong diagnostic performance for lever sign (AUC: 0.928) compared to other tests. Pivot shift test had the lowest AUC in both phases, at 0.727 and 0.731. Anterior drawer test showed moderate diagnostic accuracy but lower than lever sign. These results suggest lever sign test may be more reliable for diagnosing ACL injuries across different clinical scenarios.

The authors concluded that the lever sign test has high diagnostic accuracy for ACL injuries in acute, chronic, and postreconstructive phases. Lever sign outperformed other tests in terms of sensitivity and AUC values. The test's reproducibility and ease of performance make it a valuable tool for clinicians. The study supports using lever sign as a primary diagnostic test in ACL assessment. No prior work had resolved how lever sign compares to established methods in postreconstructive patients. The findings suggest lever sign may be more reliable than Lachman or pivot shift tests in certain cases. The authors propose that incorporating lever sign into clinical practice could improve diagnostic accuracy. These conclusions are based on the observed statistical performance and clinical reproducibility of the test.