Sensitivity and Specificity of Anterior Cruciate Clinical Examination in Acute Setting Before and After Hemarthrosis Aspiration

Objective: To define the accuracy of the clinical test for assessing anterior cruciate ligament (ACL) tears on the acute setting before and after hemarthrosis aspiration. ACL is among the most commonly injured ligament of the knee in sports injuries.The most frequently used physical examinations to diagnose an ACL injury are the Lachman test, anterior drawer test, and pivot shift test. After acute complete ACL injury patients present to clinics with hemarthrosis in the knee joint. It was hypothesized that sensitivity and specificity of Lachman test, anterior drawer test, and pivot shift test increases after hemarthrosis aspiration. Material and Methods: 62 patients consulted due to twisting knee injury with hemarthrosis were enrolled in the study. Patients were examined by an emergency physician and a senior orthopedic consultant. All three tests were performed before and after hemarthrosis aspiration and sensitivity, and specificity of tests was recorded after MR imaging. Visual analog scala (VAS) scores for pain before and after aspiration were recorded. Results: Hemarthrosis aspiration significantly reduced VAS scores. Aspiration improved sensitivity of all three diagnostic tests but did not affect specificity Lachman test has best diagnostic accuracy to detect ACL rupture in acute conditions. Conclusion: Hemarthrosis aspiration improved the sensitivity of all three tests both for orthopedic consultants and emergency physicians but did not affect specificity.