Document Detail


Accuracy and reliability of anterior cruciate ligament clinical examination in a multidisciplinary sports medicine setting.
MedLine Citation:
PMID:  20215888     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the accuracy and reliability of anterior cruciate ligament (ACL) clinical examination in a multidisciplinary sports medicine setting. DESIGN: Retrospective review of patient charting. SETTING: Community-based multidisciplinary sports medicine clinic. PATIENTS: One hundred twelve patients with surgically confirmed ACL tear. INTERVENTIONS: Review of therapist, physician, and orthopedic surgeon charting. MAIN OUTCOME MEASURES: Scoring for the anterior drawer, Lachman, and pivot shift tests completed during clinical examination. Coefficient of agreement (P(o)) was calculated for each assessment technique to determine the interrater reliability. Sensitivity of assessment was determined by comparing patient's arthroscopic surgical results against clinician's scoring. RESULTS: On average, P(o) values indicated only moderate levels of interrater reliability (anterior drawer, x = 0.57; Lachman, x = 0.45; pivot shift, x = 0.53), with great variation observed between clinician's scoring for each assessment technique. Accuracy testing demonstrated that the Lachman test had the highest level of sensitivity when administered by orthopedic surgeons (x = 86%) and that sensitivity varied greatly among clinician groups and by assessment technique (range, 15%-87%). CONCLUSIONS: In sports medicine, unreliable or inaccurate clinical examination confounds the clinician's ability to make informed decisions regarding appropriate patient referral and treatment interventions. Our results indicate that levels of accuracy and reliability for clinical examination of the ACL within a multidisciplinary sports medicine setting may be much lower than previously reported within the literature. Further research is needed to clarify whether a standardized approach to ACL clinical examination could enhance levels of accuracy and reliability among clinicians working in a multidisciplinary setting.
Authors:
J Peeler; J Leiter; P MacDonald
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine     Volume:  20     ISSN:  1536-3724     ISO Abbreviation:  Clin J Sport Med     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-10     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9103300     Medline TA:  Clin J Sport Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  80-5     Citation Subset:  IM    
Affiliation:
Department of Human Anatomy & Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada. peelerj@cc.umanitoba.ca
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Ambulatory Care Facilities
Anterior Cruciate Ligament / injuries*
Humans
Knee Injuries / diagnosis*
Middle Aged
Orthopedics
Patient Care Team*
Physical Examination*
Physical Therapy (Specialty)
Primary Health Care
Reproducibility of Results
Retrospective Studies
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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