Comparison of Diagnostic Accuracy of Lever Sign Test with Arthroscopic Findings

Diagnosing an anterior cruciate ligament (ACL) rupture based on a physical examination is a challenge for both surgeons and surgeon’s assistant. The Lever sign test has been developed as a new physical examination to overcome the practical limitations of routine clinical trials and optimize diagnosis. The aim of the present study was to evaluate the reliability and diagnostic value and outcome of the Lever test.

In this prospective diagnostic study, 154 patients who were candidates for arthroscopic surgery were evaluated. Prior to the tests, patients' clinical manifestations were recorded. Lever, Drawer, Lachman and pivot diagnostic tests were performed by an orthopedic surgeon and an experienced surgeon assistant before and after anesthesia. The accuracy, sensitivity and specificity of these tests compared to arthroscopy findings were calculated as a gold standard. The ease of performing the tests was assessed from the point of view of the performers as well as the patients' pain during the test with the standard pain score (Visual Analog Scale, VAS).

The accuracy, sensitivity and specificity of Lever test before anesthesia were calculated as 70.5, 63, and 91.3 and after anesthesia 74.5, 66.51, 90.23 respectively. Among the tests, Lever was the easiest before anesthesia with 68%, and after anesthesia with 74.5% it was the easiest after drawer test from the point of view of the operators. Lever test with a vas score of 4.01 had the least pain during the test.

The lever test can be performed clinically easily and has little pain for the patient and is comparable to other orthopedic tests in terms of accuracy, sensitivity and specificity. This test is recommended as an effective orthopedic maneuver, along with other ACL tear diagnostic tools, especially when other tests are associated with severe pain.