Diagnostic Accuracy of Physical Examination Tests for Suspected Acute Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis.

The review only included studies of acute injuries (within six weeks), so the results do not apply to chronic ACL injuries. Three of the eight studies had a high risk of bias because they did not report the time interval between the physical exam and the reference standard (MRI or arthroscopy). The analysis did not distinguish between tests performed on awake patients versus those performed under anesthesia, which could affect test accuracy due to muscle relaxation. The review excluded patients with associated injuries like meniscus tears or osteoarthritis, which are common in real-world clinical presentations, limiting generalizability. EMBASE, a major database, was not searched, which may have led to the omission of relevant studies.

The authors declared no conflicts of interest. The study did not receive specific grants from public, commercial, or not-for-profit funding agencies.

Do not rely on a single physical examination test to diagnose an acute ACL injury. While the lever sign and pivot shift tests showed the best accuracy for ruling out and confirming injury respectively, the authors note that a complete diagnosis using one test is difficult, especially in the acute phase where pain and swelling are present. Combining multiple tests is necessary to reduce incorrect diagnoses.