EVIDENCE BASED MEDICINE: EXAMINING ANTERIOR CRUCIATE LIGAMENT TESTING

By: Laura Wind

ANTERIOR CRUCIATE LIGAMENT TEARS

oAnterior cruciate ligament (ACL) tears, due to anterior translation of the tibia, are a common injury among the athletic population. (Spindler)

oUsually occur by direct force, non-contact rotational or non-contact hyperextension at the knee, & are typically acute injuries with pivoting/cutting motions being common stresses.

oCharacteristics include: “popping” sensation or sound described as coming from inside the joint, rapid swelling, & excess laxity of the ACL. (Starkey)

ACL EVALUATION TECHNIQUESoEvaluating should begin with a patient’s

description of what happened.oClinically, ACL tears may present with

edema/swelling in the area. Pain with palpation may not show signs of pain acutely.

oRange of motion exam will reveal limited knee flexion & extension usually due to swelling. (Starkey)

oSeveral special tests are present for this pathology with the main 2 used for evaluation being the Anterior Drawer test & Lachman’s test.

ANTERIOR DRAWER TESToThis has been found to have higher

sensitivity & specificity in chronic conditions. (Benjaminise)

oExamination Values: Sensitivity-0.55/Specificity-0.92Positive Likelihood Ratio-7.3/Negative Likelihood Ratio-0.5oWhat does this mean? Some aspects of this test are reliable, but it is a better test when used with other techniques. (Geraets)

LACHMAN’S TESToLachman’s test is considered the Gold

Standard for ACL diagnosis. It has been compared to other joint stability tests & MRIs.(Dejour)

oExamination Values:Sensitivity-0.85/Specificity-0.94Positive Likelihood Ratio-10.2/Negative Likelihood Ratio-0.2oWhat does this mean?Lachman’s test is the best representation of whether an ACL injury is present, & is highly useful when put to use with MRIs, other special tests, & a combination of other joint special tests. (Geraets)

CONCLUSIONBoth tests play a role in determining the present of an ACL injury. The combination of special tests can help to create a complete screening of the presence or absence of an ACL tear.

REFERENCES1. Spindler, K.P and Wright, R.W. (2008). Anterior Cruciate Ligament Tear. New England Journal of Medicine. 359(20), 2135-2142.2. Starkey, C., Brown, S.D., and Ryan, J.L. (2002). Examination of Orthopedic and Athletic Injuries: Third Edition.3. Benjaminse, A., Gokeler, A., and Van Der Schans, C.P. (2006). Clinical Diagnosis of an Anterior Cruciate Ligament Rupture: A Meta-Analysis. Journal of Orthopedic and Sports Physical Therapy. 36(5), 267-288.4. Dejour, D., Ntagiopoulos, P. G., Saggin, P. S., and Panisset, J.C. (2012), The Diagnostic Value of Clinical Tests, Magnetic Resonance Imaging, and Instrumented Laxity in the Differentiation of Complete Versus Partial Anterior Cruciate Ligament Tears. Arthoscopy Association of North America. 5. Geraets, S.E.W., Meuffels, D.E., Van Meer, B.L, Breedveldt Boer, H.P, Bierma-Zeinstra, S.M.A., and Reijman, M. (2013), Diagnostic Value of Medical History and Physical Examination of Anterior Cruciate Ligament Injury: Comparison Between Primary Care Physician and Orthopedic Surgeon. Knee Surgery, Sports Traumatology, and Arthoscopy. 1-12.