Twenty-eight studies were included in the review. The total number of participants was not clear.
Only 3 studies described an independent blind comparison of the index test with a reference standard of diagnosis; one of these and another 2 studies interpreted the index test independently of other clinical information. Three further studies were free from verification bias. The spectrum of disease varied across the included studies and only 11 studies reported the index test in sufficient detail to permit its replication.
Anterior drawer test without anaesthesia.
The pooled estimates for sensitivity (20 studies) and specificity (12 studies) were 55% (95% CI: 52, 58) and 92% (95% CI: 90, 94), respectively. The pooled estimates for the LR+ and LR- (12 studies) were 7.3 (95% CI: 3.5, 15.2) and 0.5 (95% CI: 0.4, 0.6), respectively. Diagnostic performance was similar when the data were subgrouped for chronic and acute disease.
Anterior drawer test with anaesthesia.
The pooled estimates of sensitivity (15 studies) and specificity (7 studies) were 77% (95% CI: 75, 80) and 87% (95% CI: 82, 91), respectively. The pooled estimates of the LR+ and LR- (7 studies) were 5.9 (95% CI: 0.9, 38.2) and 0.4 (95% CI: 0.2, 0.8), respectively. Diagnostic performance was similar when the data were sub-grouped for chronic and acute disease; sensitivity appeared slightly higher in chronic disease.
Lachman test without anaesthesia.
The pooled estimates of sensitivity (21 studies) and specificity (12 studies) were 85% (95% CI: 83, 87) and 94% (95% CI: 92, 95), respectively. The pooled estimates of the LR+ and LR- (12 studies) were 10.2 (95% CI: 4.6, 22.7) and 0.2 (95% CI: 0.1, 0.3), respectively. Diagnostic performance was similar when the data were sub-grouped for chronic and acute disease.
Lachman test with anaesthesia.
The pooled estimates of sensitivity (15 studies) and specificity (5 studies) were 97% (95% CI: 96, 98) and 93% (95% CI: 89, 96), respectively. The pooled estimates of the LR+ and LR- (5 studies) were 12.9 (95% CI: 1.5, 108.5) and 0.1 (95% CI: 0.0, 0.3), respectively. Diagnostic performance was similar when the data were sub-grouped for chronic and acute disease.
Pivot shift test without anaesthesia.
The pooled estimates of sensitivity (15 studies) and specificity (8 studies) were 24% (95% CI: 21, 27) and 98% (95% CI: 96, 99), respectively. The pooled estimates of the LR+ and LR- (8 studies) were 8.5 (95% CI: 4.7, 15.5) and 0.9 (95% CI: 0.8, 1.0), respectively. Diagnostic performance was similar when the data were sub-grouped for chronic and acute disease; sensitivity appeared slightly higher in chronic disease.
Pivot shift test with anaesthesia.
The pooled estimates of sensitivity (13 studies) and specificity (6 studies) were 74% (95% CI: 71, 77) and 99% (95% CI: 96, 100), respectively. The pooled estimates of the LR+ and LR- (6 studies) were 20.9 (95% CI: 2.8, 156.2) and 0.3 (95% CI: 0.1, 0.7), respectively. Specificity was similar when the data were subgrouped for chronic and acute disease; sensitivity was slightly higher for both subgroups.