Elsevier

Manual Therapy

Volume 20, Issue 3, June 2015, Pages 402-411
Manual Therapy

Systematic review
The reliability of physical examination tests for the diagnosis of anterior cruciate ligament rupture – A systematic review

https://doi.org/10.1016/j.math.2014.11.003Get rights and content

Abstract

Background

Despite their frequent application in routine care, a systematic review on the reliability of clinical examination tests to evaluate the integrity of the ACL is missing.

Objectives

To summarize and evaluate intra- and interrater reliability research on physical examination tests used for the diagnosis of ACL tears.

Methods

A comprehensive systematic literature search was conducted in MEDLINE, EMBASE and AMED until May 30th 2013. Studies were included if they assessed the intra- and/or interrater reliability of physical examination tests for the integrity of the ACL. Methodological quality was evaluated with the Quality Appraisal of Reliability Studies (QAREL) tool by two independent reviewers.

Results

110 hits were achieved of which seven articles finally met the inclusion criteria. These studies examined the reliability of four physical examination tests. Intrarater reliability was assessed in three studies and ranged from fair to almost perfect (Cohen's k = 0.22–1.00). Interrater reliability was assessed in all included studies and ranged from slight to almost perfect (Cohen's k = 0.02–0.81). The Lachman test is the physical tests with the highest intrarater reliability (Cohen's k = 1.00), the Lachman test performed in prone position the test with the highest interrater reliability (Cohen's k = 0.81). Included studies were partly of low methodological quality. A meta-analysis could not be performed due to the heterogeneity in study populations, reliability measures and methodological quality of included studies.

Conclusion

Systematic investigations on the reliability of physical examination tests to assess the integrity of the ACL are scarce and of varying methodological quality.

Section snippets

Background

Rupture of the anterior cruciate ligament (ACL) is a severe knee injury, which is often acquired during sporting activities (Alentorn-Geli et al., 2009, Gianotti et al., 2009), and often results in instability. This subsequently leads to meniscal and cartilage lesions and/or functional impairments (Lohmander et al., 2004, Michalitsis et al., 2013, Sri-Ram et al., 2013). Early diagnosis and treatment is therefore necessary. To diagnose an ACL tear, information obtained from patient history,

Objective

To our knowledge, there have been no published systematic reviews conducted to determine the intra- and interrater reliability of physical examination tests for ACL injuries. Accordingly, the objective of this systematic review was to summarize and evaluate intra- and interrater reliability research on physical examination tests used for the diagnosis of ACL tears.

Data sources and search strategy

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines during the whole searching and reporting process of this review (Moher et al., 2009). The PRISMA statement aims to improve the reporting of systematic reviews and meta-analyses.

We executed a comprehensive systematic literature search in the following databases via the Ovid interface until May 30th, 2013: MEDLINE from 1946, EMBASE from 1974, and the Allied and Complementary Medicine Database (AMED)

Study selection

The summary of the literature search results and study selection can be seen in the PRISMA flow chart (Fig. 2) as described in the PRISMA statement (Moher et al., 2009). After evaluation of the 110 search hits, 19 publications met the predefined criteria and were retrieved and checked for eligibility (Althoff et al., 1981, Wirth and Kolb, 1985, Decker and Ruf, 1988, Cooperman et al., 1990, Duggan and Ross, 1991, Fleming et al., 1992, Scharlig et al., 1992, Gambaretti et al., 1995, Konig et al.,

Main findings

This systematic review identified seven articles, which examined the reliability of four physical examination tests with varying intrarater as well as interrater reliability. The included studies were partly of low methodological quality according to the methodological assessment using the QAREL tool. Because of methodological quality flaws, different and partially inadequate reliability measures of included studies, meta-analysis of results was not possible.

Intrarater reliability

According to our results, the

Acknowledgement

The authors would like to thank Dr Janice Hegewald from the Technical University Dresden for the English language review.

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    The first two authors (A.F. and T.L.) contributed equally to this work.

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