1. https://youtu.be/T9ujIYIctdw Physio tutors: Pictures
Education and Use of the Lelli Test in the Clinical Setting Nathalie de la Torre, Eduardo Escobar, Stephanie Nelson, MS, LAT, ATC MSAT Tarleton State University
Introduction
The knee ligament most susceptible to injury is the anterior cruciate.²˒⁵˒⁸ Detection of a ruptured ACL tear is pivotal in the course of injury care and management process.⁸ The gold reference standard for diagnosing an ACL tear has been arthroscopic evaluation.²˒⁵ However, a MRI may be used as an alternate because it is non-invasive, and it has a sensitivity and specificity of 98% and 94%.²˒⁵ Before the gold reference standard is used, a combination of physical examinations must be performed. The three physical examinations chosen by surgeons because of the exams’ highly researched validity are the Lachman test, Anterior Drawer test, and the Pivot shift. ²˒⁵˒⁶˒⁸ In 2005, a clinical exam called the Lelli test or Lever Sign test was created by Alessandro Lelli of Bologna, Italy.²˒¹⁰ The Lelli test was designed to forgo the factors that negatively influence the results of the previously listed tests. Since there has been little research, the test’s validity has not been verified.
Purpose
The purpose of this study was to:
Review the literature over the Lelli test
Understand how the Lelli test is used by medical professionals
Compare diagnostic accuracy
Provide exact instructions on how to perform the Lelli test
Share findings
Encourage future research
Methods
A literature review identified and critiqued 10 articles over the Lelli test. Research studies were found using databases such as: SportsDiscus, Medline, Health Source: Nursing/Academic Ed., and Google Scholar.
A video that included evidence based research was selected from the internet, and implemented into the educational video.
Participants for interviews were selected from local areas:
High School Athletic Trainers
Collegiate Athletic Trainers
Orthopedic surgeons
Participants will be interviewed about their:
History with exam
Implementation of the Lelli test in the clinical setting
Trust in the supporting evidence of the exam
Preference and trust when comparing all four exams
Sideline exam procedure
Preference in sideline exams and explanation Patient Observations
Results
Inconsistent results for the Lelli test were found in the literature.
The results of the articles stated the Lelli is high in sensitivity and low in specificity, sensitivity and specificity are equal or near equal, or specificity is higher than sensitivity.
Lelli Procedure
Results of Interviews
Conclusion
Limitations of the studies are as follows: small sample sizes, lower number of acute injuries, few partial tears, differences in techniques, low number of female participants, and absence of specificity.
The test should be labeled as experimental until future research, correcting the mistakes from previous studies.
Researchers will begin the interview process in October.
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1.Chong, A., Whitetree, C., Priddy, M., Zimmerman, P., Haeder, P., & Prohaska, D. (2017). Evaluating Different Clinical Diagnosis of Anterior Cruciate Ligament Ruptures in Providers with Different Training Backgrounds. The Iowa Orthopedic Journal, 37(71-79). 2. Deveci, A., Cankaya, D., Yilmaz, S., Özdemir, G., Arslantaş, E., & Bozkurt, M. (2015). The arthroscopical and radiological corelation of lever sign test for the diagnosis of anterior cruciate ligament rupture. Springerplus, 4(1), 830.
3.Jarbo, K. A., Hartigan, D. E., Scott, K. L., Patel, K. A., & Chhabra, A. (2017). Accuracy of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries. Orthopaedic journal of sports medicine, 5(10). 4. Koster, C. H., Harmsen, A. M., Lichtenberg, M. C., & Bloemers, F. W. (2018). ACL injury: How do the physical examination tests compare?. The Journal Of Family Practice, 67(3),
5. Lelli, A., Turi, R., Spenciner, D., Dòmini, M., Di Turi, R. P., Spenciner, D. B., & Dòmini, M. (2016). The "Lever Sign": a new clinical test for the diagnosis of anterior cruciate ligament rupture. Knee Surgery, Sports Traumatology, Arthroscopy, 24(9), Lichtenberg, M. C., Koster, C. H., Teunissen, L. P., Oosterveld, F. G., Harmsen, A. M., Haverkamp, D., & Faber, I. R. (2018). Does the Lever Sign Test Have Added Value for Diagnosing Anterior Cruciate Ligament Ruptures?. Orthopaedic journal of sports medicine, 6(3),
7.Massey, P.A., Harris, J.D., Winston, L.A., Linter, D.M, Delgado, D.A., & McCulloch, P.C. (2017). Critical Analysis of the Lever Test for Diagnosis of Anterior Cruciate Ligament Insufficiency. The Journal of Arthroscopic and Related Surgery, 33(8), Mulligan, E. P., Anderson, A., Watson, S., & Dimeff, R. J. (2017). THE DIAGNOSTIC ACCURACY OF THE LEVER SIGN FOR DETECTING ANTERIOR CRUCIATE LIGAMENT INJURY. International Journal Of Sports Physical Therapy, 12(7),
9. SAIF-UR-REHMAN, M. H. Y., ASHRAF, M. F., SALEEM, M., & ANIS, Y. (2016). Accuracy of Lelli Test in Diagnosing Anterior Cruciate Ligament Tear taking Arthroscopy as Gold Standard. 10. Thapa, S. S., Lamichhane, A. P., & Mahara, D. P. (2015). Accuracy of Lelli test for anterior cruciate ligament tear. Journal of Institute of Medicine, 38(2).