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1.
Arch Orthop Trauma Surg ; 142(8): 1979-1983, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34510241

RESUMEN

INTRODUCTION: The objective of this study was to assess the diagnostic value of the "lever sign test" to diagnose ACL rupture and to compare this test to the two most commonly used, the Lachman and anterior drawer test. METHOD: This prospective study was performed in the ED of the Cliniques Universitaires Saint-Luc (Brussels, Belgium) from March 2017 to May 2019. 52 patients were included undergoing knee trauma, within 8 days, with an initial radiograph excluding a fracture (except Segond fracture or tibial spine fracture). On clinical investigation, patients showed a positive lever sign test and/or a positive Lachman test and/or a positive anterior drawer test. Exclusion criteria were a complete rupture of the knee extensor mechanism and patellar dislocation. All the physicians involved in this study were residents in training. An MRI was performed within 3 weeks for all included patients after the clinical examination. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were investigated for all three tests with MRI used as our reference standard. RESULTS: Forty out of 52 patients suffered an ACL rupture (77%) and 12 did not (23%). The sensitivity, specificity, PPV and NPV of the lever sign test were respectively 92.5%, 25% 82% and 50%. Those of the Lachman test were 54%, 54.5%, 81% and 25%, and those of the anterior drawer test were 56%, 82%, 90.5% and 37.5%. Twelve out of 40 ACL ruptures (30%) were diagnosed exclusively with a positive lever sign test. CONCLUSION: When investigating acute ACL ruptures (< 8 days) in the ED, the lever sign test offers a sensitivity of 92.5%, far superior to that of other well-known clinical tests. The lever sign test is relatively pain-free, easy to perform and its visual interpretation requires less experience. Positive lever sign test at the ED should lead to an MRI to combine high clinical sensitivity with high MRI specificity.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Servicio de Urgencia en Hospital , Examen Físico , Ligamento Cruzado Anterior/diagnóstico por imagen , Lesiones del Ligamento Cruzado Anterior/diagnóstico , Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Humanos , Articulación de la Rodilla , Imagen por Resonancia Magnética , Examen Físico/métodos , Estudios Prospectivos , Rotura/diagnóstico , Rotura/diagnóstico por imagen , Sensibilidad y Especificidad
2.
Acta Orthop Belg ; 70(4): 299-305, 2004 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-15481411

RESUMEN

Growth hormone (GH) therapy is widely used in children; it may have various severe orthopaedic complications. Slipped capital femoral epiphysis, Legg-Calvé-Perthes disease, scoliosis and carpal tunnel syndrome may occur with GH treatment. Before beginning GH therapy, it is important to take into account all the risk factors of the individual patient, as some conditions could contraindicate GH treatment. During GH treatment, close monitoring with both clinical and radiographic examination is mandatory. The paediatric orthopaedic surgeon will frequently be asked about the management of these complications and about the necessity for treatment arrest. The authors review the orthopaedic complications which the orthopaedic surgeon may encounter in patients treated with GH.


Asunto(s)
Trastornos del Crecimiento/tratamiento farmacológico , Hormona de Crecimiento Humana/efectos adversos , Enfermedades Musculoesqueléticas/inducido químicamente , Adolescente , Síndrome del Túnel Carpiano/inducido químicamente , Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/cirugía , Niño , Preescolar , Epífisis Desprendida/inducido químicamente , Epífisis Desprendida/diagnóstico por imagen , Epífisis Desprendida/cirugía , Femenino , Estudios de Seguimiento , Trastornos del Crecimiento/diagnóstico , Hormona del Crecimiento/deficiencia , Hormona de Crecimiento Humana/uso terapéutico , Humanos , Lactante , Enfermedad de Legg-Calve-Perthes/inducido químicamente , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Enfermedad de Legg-Calve-Perthes/cirugía , Masculino , Enfermedades Musculoesqueléticas/diagnóstico por imagen , Enfermedades Musculoesqueléticas/cirugía , Radiografía , Medición de Riesgo , Escoliosis/inducido químicamente , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
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