Reliabilität und Validität des Lever Sign Tests bei Verdacht auf Band- und/oder Meniskus-Verletzung des Knies: ein Vergleich zwischen Orthopäde und Physiotherapeut

Zusammenfassung

Einleitung Das Ziel dieser Studie war die Untersuchung der Intertester-Reliabilität und Validität des Lever Sign-Tests. Der Intertester-Reliabilität wurde in bisherigen Studiennoch wenig Beachtung geschenkt. Um Vergleiche mit anderen Studien ziehen zu können, wurde zusätzlich die Intertester-Reliabilität und Validität des Lachman- und Anterior Drawer-Tests berechnet.

Patienten/Material und Methoden Eingeschlossen wurden Patienten und Patientinnen zwischen 18 und 50 Jahren mit Verdacht auf Band- und/oder Meniskus-Verletzungen. Ausschlusskriterien waren Verdacht auf bösartige, systemische oder zentralneurologische Erkrankungen, akute Knorpelverletzungen, Verdacht auf Fraktur oder Kenntnis über den Kniebefund der Teilnehmenden. Die Tests wurden von einem erfahrenen Orthopäden und einem Physiotherapeuten randomisiert und verblindet durchgeführt. Für die Intertester-Reliabilität wurde der Cohen’s Kappa und für die Validität die Sensitivität und Spezifität, der Positiv und Negativ Prädiktive Wert und die Positive und Negative Likelihood ratio berechnet. Der MRI-Befund wurde als Goldstandard genutzt.

Ergebnisse Sechsunddreissig Patienten und Patientinnen wurden in die Studie eingeschlossen. Davon waren 27 männlich (75%) und 9 weiblich (25%). Die Prävalenz von vorderen Kreuzbandläsionen lag bei 44,4%. Der Cohen’s Kappa (κ) des Lever Sign-Tests lag bei κ=0,6 (KI 95% [0,29, 0,91]), beim Lachman-Test bei κ=0,64 (KI 95% [0,35, 0,93]) und beim Anterior Drawer-Test bei κ=0,63 (KI 95% [0,3, 0,95]). Die Sensitivität des Lever Sign-Tests war für den Orthopäden und Physiotherapeuten 0,53 und 0,40, die Spezifität 0,89 und 0,79, der Positiv Prädiktive Wert 0,80 und 0,60, der Negativ Prädiktive Wert 0,70 und 0,62, die Positive Likelihood ratio 4,80 und 1,90 und die Negative Likelihood ratio 0,76 und 0,53.

Schlussfolgerung Die geschätzte Intertester-Reliabilität des Lever Sign-Tests war gut. Der Lever Sign-Test eignet sich als Ergänzung zum Lachman-Test, der in der Literatur als validester Test angesehen wird. Die Schwächen und Unklarheiten des Funktionsmechanismus des Lever Sign-Tests dürfen nicht ignoriert werden und sollten weiter erforscht werden.

Abstract

Introduction The purpose of this study was to investigate the intertester reliability and validity of the Lever Sign Test. Intertester reliability has received little attention in previous studies. In order to make comparisons with other studies, the intertester reliability and validity of the Lachman and Anterior Drawer Tests were also calculated.

Patients/Material and Methods Patients between 18 and 50 years of age with suspected ligament and/or meniscus injuries were included. Exclusion criteria were suspected malignant, systemic, or central neurologic disease, acute cartilage injury, suspected fracture, or knowledge of the participant's knee findings. Testing was randomized and blinded by an experienced orthopaedic surgeon and a physical therapist. Cohen's kappa was calculated for intertester reliability. Sensitivity and specificity, positive and negative predictive value, and positive and negative likelihood ratio were calculated. MRI findings were used as the gold standard.

Results Thirty-six patients were enrolled in the study, 27 male (75%) and 9 female (25%). The prevalence of anterior cruciate ligament lesions was 44.4%. Cohen’s kappa (κ) was κ=0.6 (CI 95% [0.29, 0.91]) for the Lever Sign Test, κ=0.64 (CI 95% [0.35, 0.93]) for the Lachman test, and κ=0.63 (CI 95% [0.3, 0.95]) for the Anterior Drawer Test. The sensitivity of the Lever Sign Test was 0.53 and 0.40 for the orthopaedic surgeon and physical therapist, respectively, specificity was 0.89 and 0.79, the positive predictive value was 0.80 and 0.60, the negative predictive value was 0.70 and 0.62, the positive likelihood ratio was 4.80 and 1.90, respectively, and the negative likelihood ratio was 0.76 and 0.53.

Conclusion The estimated intertester reliability of the Lever Sign Test was good. The Lever Sign Test is suitable as a complement to the Lachman Test, which is considered the most valid test in the literature. The weaknesses and ambiguities of the operating mechanism of the Lever Sign Test should not be ignored and should be further explored.

Schlüsselwörter

Lever Sign Test - Intertester-Reliabilität - Validität - VKB - Vorderes Kreuzband

Keywords

Lever Sign Test - intertester reliability - validity - ACL - anterior cruciate ligament

Publication History

Received: 21 February 2023

Accepted after revision: 30 July 2023

Article published online:
04 December 2023

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