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

Study design: Systematic literature review.

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.