Comparative Diagnostic Accuracy of the Lever Sign, Lachman Test, and Lateral Pivot Shift Test for Detecting Complete Anterior Cruciate Ligament Tears

Abstract

Background: Clinical examination remains fundamental in diagnosing anterior cruciate ligament (ACL) tears, with various tests available. This study aimed to compare the diagnostic accuracy of the Lachman test, Lever sign, and Lateral pivot shift test in diagnosing complete ACL tears. Methods: A prospective diagnostic accuracy study was conducted on 61 patients with suspected ACL injuries. Each patient underwent all three clinical tests, with results compared against magnetic resonance imaging and arthroscopic findings. Sensitivity, specificity, and diagnostic accuracy were calculated for individual tests and their combinations. Results: The study included 33 confirmed ACL tears and 28 cases without tears. The Lachman test showed high sensitivity (90.9%) but moderate specificity (67.9%). The Lever sign demonstrated balanced sensitivity (84.8%) and specificity (85.7%). The Lateral pivot shift test exhibited perfect specificity (100%) but lower sensitivity (45.5%). The combination of all three tests achieved the highest diagnostic accuracy (96.7%, p<0.001), significantly outperforming individual tests. Conclusion: While each test has unique diagnostic strengths, the combination of all three tests provides optimal diagnostic accuracy. This study supports a comprehensive clinical examination approach using multiple tests for accurate ACL tear diagnosis.