Meta-analysis of studies of the validity of three physical diagnostic tests for the demonstration of rupture of the anterior cruciate ligament: the anterior drawer test, the Lachman test, and the pivot shift test.
By means of computerised searches of Medline (1966-2004) and Embase (1980-2004), publications were selected that were written in English, French, German or Dutch and in which the value of at least one physical diagnostic test for rupture of the anterior cruciate ligament was assessed in comparison with the findings using arthrotomy, arthroscopy or MRI as the gold standard. Two investigators independently selected the publications, assessed the methodological quality and extracted data using a standardised protocol. Wherever appropriate and possible, an estimate was made of the (pooled) sensitivity, specificity, and positive and negative predictive value of each test with the aid of a meta-analysis.
Seventeen studies met the inclusion criteria. None of these assessed the index test and reference test independently (with blinding), and all but two displayed verification bias. The pivot shift test had the highest positive predictive value, and the Lachman test the highest negative predictive value. The anterior drawer test was of little diagnostic value.
Physical diagnostic tests may be useful in the diagnosis of anterior cruciate-ligament ruptures. The clinical relevance of the test results, however, depends on the prior probability of the presence of such a rupture and is therefore different for general practitioners and specialists; the pivot shift test has the greatest diagnostic value in general practice and the Lachman test in specialist care.
Ned Tijdschr Geneeskd 2005;149:83-8