Accuracy and Reliability of Anterior Cruciate Ligament Clinical Examination in a Multidisciplinary Sports Medicine Setting

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) over bar = 0.57; Lachman, (x) over bar = 0.45; pivot shift, (x) over bar = 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) over bar = 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.