The "Lever Sign": a new clinical test for the diagnosis of anterior cruciate XXXX .

@entity1 @entity397 @entity75 @entity291
PURPOSE: A new clinical test for the diagnosis of @entity397 is described: the so-called "Lever Sign". This prospective study on four groups of @entity1 divided subjects on the basis of MRI findings (complete or partial @entity75 ) and the clinical phase of the injury (acute or chronic). The hypothesis was that this manual test would be diagnostic for both partial and complete tears of the ACL regardless of the elapsed time from injury. METHODS: A total of 400 @entity1 were evaluated and divided into four, equal-sized groups based on time elapsed from injury and MRI findings: Group A (acute phase with positive MRI for complete @entity397 ), Group B (chronic phase with positive MRI for complete @entity397 ), Group C (acute phase with positive MRI for partial @entity397 ), and Group D (chronic phase with positive MRI for partial @entity397 ). Clinical assessment was performed with the Lachman test, the Anterior Drawer test, the Pivot Shift test, and the Lever Sign test. The Lever Sign test involves placing a fulcrum under the supine @entity1 's @entity291 and applying a downward force to the quadriceps. Depending on whether the ACL is intact or not, the @entity1 's heel will either rise off of the examination table or remain down. Additionally, the Lever Sign test was performed on the un-injured leg of all 400 @entity1 as a control. RESULTS: All tests were nearly 100  % sensitive for @entity1 with chronic, complete tears of the ACL. However, for @entity1 with acute, partial tears, the sensitivity was much lower for the Lachman test (0.42), Anterior Drawer test (0.29), and Pivot Shift test (0.11), but not the Lever Sign test (1.00). CONCLUSION: In general, chronic, complete tears were most successfully diagnosed but acute, partial tears were least successfully diagnosed. The Lever Sign test is more sensitive to correctly diagnosing both acute and partial tears of the ACL compared with other common manual tests. The clinical relevance is that some @entity397 may be more accurately diagnosed.
