Publicatie
Publicatie datum
Fysische diagnostiek - de waarde van enkele gebruikelijke tests voor het aantonen van een voorstekruisbandruptuur: meta-analyse.
Plas, C.G. van der, Opstelten, W., Devillé, W.L.J.M., Bijl, D., Bouter, L.M., Scholten, R.J.P.M. Fysische diagnostiek - de waarde van enkele gebruikelijke tests voor het aantonen van een voorstekruisbandruptuur: meta-analyse. Nederlands Tijdschrift voor Geneeskunde: 2005, 149(2), 83-88
Objective: Meta-analysis of studies of the validity of three physical diagnotic tests for the
demonstration of rupture of the anterior cruciate ligament: the anterior drawer test, the Lachman
test, and the pivot shift test. Design: Meta-analysis. Method: By means of computerised searches of
Medline (1966-2004) and DEmbase (1980-2004) publications were selected that were written in English,
French, German or Dutch and in which the value of at least one physical diagnostic test for rupture
of the anterior cruciate ligament was assessed in comparison with the findings using arthrotomy,
arthroscopy, or MRI as the gold standard. Two investigators independently selected the publications,
assessed the methodological quality and extracted data using a standardised protocol. Wherever
apporpriate and possible, an estimate was made of the (pooled) sensitivity, specificity, and
positive and negative predictive value of each test with the aid of a meta-analysis. Results:
Seventeen studies met the inclusion cirteria. None of these assessed the index test and reference
test independently (with blinding), and all but two displayed verification bias. The pivot shilft
test had the highest positive prediction value, and the Lachman test the highest negative predictive
value. The anterior drawer test was of little diagnostic value. Conclusion: Physical diagnostic
tests may be useful in the diagnosis of anterior cruciate-ligament ruptures. The clinical relevance
of the test results, however, depends on the prior probability of the presence of such a rupture and
is therefore different for general practitioners and specialists; the pivot shift test has the
greatest diagnostic value in general practice and the Lachman test in specialist care. (aut.ref.)
demonstration of rupture of the anterior cruciate ligament: the anterior drawer test, the Lachman
test, and the pivot shift test. Design: Meta-analysis. Method: By means of computerised searches of
Medline (1966-2004) and DEmbase (1980-2004) publications were selected that were written in English,
French, German or Dutch and in which the value of at least one physical diagnostic test for rupture
of the anterior cruciate ligament was assessed in comparison with the findings using arthrotomy,
arthroscopy, or MRI as the gold standard. Two investigators independently selected the publications,
assessed the methodological quality and extracted data using a standardised protocol. Wherever
apporpriate and possible, an estimate was made of the (pooled) sensitivity, specificity, and
positive and negative predictive value of each test with the aid of a meta-analysis. Results:
Seventeen studies met the inclusion cirteria. None of these assessed the index test and reference
test independently (with blinding), and all but two displayed verification bias. The pivot shilft
test had the highest positive prediction value, and the Lachman test the highest negative predictive
value. The anterior drawer test was of little diagnostic value. Conclusion: Physical diagnostic
tests may be useful in the diagnosis of anterior cruciate-ligament ruptures. The clinical relevance
of the test results, however, depends on the prior probability of the presence of such a rupture and
is therefore different for general practitioners and specialists; the pivot shift test has the
greatest diagnostic value in general practice and the Lachman test in specialist care. (aut.ref.)
Objective: Meta-analysis of studies of the validity of three physical diagnotic tests for the
demonstration of rupture of the anterior cruciate ligament: the anterior drawer test, the Lachman
test, and the pivot shift test. Design: Meta-analysis. Method: By means of computerised searches of
Medline (1966-2004) and DEmbase (1980-2004) publications were selected that were written in English,
French, German or Dutch and in which the value of at least one physical diagnostic test for rupture
of the anterior cruciate ligament was assessed in comparison with the findings using arthrotomy,
arthroscopy, or MRI as the gold standard. Two investigators independently selected the publications,
assessed the methodological quality and extracted data using a standardised protocol. Wherever
apporpriate and possible, an estimate was made of the (pooled) sensitivity, specificity, and
positive and negative predictive value of each test with the aid of a meta-analysis. Results:
Seventeen studies met the inclusion cirteria. None of these assessed the index test and reference
test independently (with blinding), and all but two displayed verification bias. The pivot shilft
test had the highest positive prediction value, and the Lachman test the highest negative predictive
value. The anterior drawer test was of little diagnostic value. Conclusion: Physical diagnostic
tests may be useful in the diagnosis of anterior cruciate-ligament ruptures. The clinical relevance
of the test results, however, depends on the prior probability of the presence of such a rupture and
is therefore different for general practitioners and specialists; the pivot shift test has the
greatest diagnostic value in general practice and the Lachman test in specialist care. (aut.ref.)
demonstration of rupture of the anterior cruciate ligament: the anterior drawer test, the Lachman
test, and the pivot shift test. Design: Meta-analysis. Method: By means of computerised searches of
Medline (1966-2004) and DEmbase (1980-2004) publications were selected that were written in English,
French, German or Dutch and in which the value of at least one physical diagnostic test for rupture
of the anterior cruciate ligament was assessed in comparison with the findings using arthrotomy,
arthroscopy, or MRI as the gold standard. Two investigators independently selected the publications,
assessed the methodological quality and extracted data using a standardised protocol. Wherever
apporpriate and possible, an estimate was made of the (pooled) sensitivity, specificity, and
positive and negative predictive value of each test with the aid of a meta-analysis. Results:
Seventeen studies met the inclusion cirteria. None of these assessed the index test and reference
test independently (with blinding), and all but two displayed verification bias. The pivot shilft
test had the highest positive prediction value, and the Lachman test the highest negative predictive
value. The anterior drawer test was of little diagnostic value. Conclusion: Physical diagnostic
tests may be useful in the diagnosis of anterior cruciate-ligament ruptures. The clinical relevance
of the test results, however, depends on the prior probability of the presence of such a rupture and
is therefore different for general practitioners and specialists; the pivot shift test has the
greatest diagnostic value in general practice and the Lachman test in specialist care. (aut.ref.)