October’s Five Assessment Assistant
Accuracy of 3 Diagnostic tests for ACL tears
What?
Systematic review ultimately involving 17 studies comparing sensitivity and Specificity of the:
- Lachman’s test
- Pivot Shift
- Anterior Drawer
Who?
Inclusion criteria:
- Investigation of at least one physical diagnostic test for assessment of ACL ruptures in the knee
- The use of a reference standard of Arthrotomy, Arthroscopy, or Magnetic Resonance Imaging.
Results!
Lachman’s was the most sensitive, a negative Lachlan’s can be used to rule out ACL tear.
Pivot Shift was the most Specific and can be used to rule in a tear.
How?
Lachman’s
Patient is supine, their injured knee flexed to 20 to 30 degrees while also slightly externally rotating the injured leg. Then use one hand to stabilize the distal Femur whilst the other grasps the proximal Tibia. Next, pull the proximal tibia in an attempt to bring the Tibia against the femur stabilized. Look for pain, instability or subluxation.
Pivot shift
With the patient supine grasp the heel of the injured leg with one hand whilst the other is on the lateral part of the proximal Tibia. Then apply a Valgus and axially directed stress while internally rotating the Tibia as the knee is moved into Flexion. Look for pain, instability or subluxation.
Michael Rafla
Physiotherapist
Australian Sports Physiotherapy
Ivanhoe, Heidelberg, Coburg, Northcote, Carlton North
1300651256
0431 271 714
Scholten RJPM, Opstelten W, van der Plas CG, Bijl D, Deville WLJM, Bouter LM. Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis. J Fam Pract. 2003;52:689–694.
