Lever Sign Test
Patient lies supine with fully extended both legs. One fist of clinician is placed under the proximal third of the calf of one leg. Then, with the other hand, a downward force is applied over distal third of the patient’s quadriceps of same leg.
Negative test: When the ACL is intact the downward force applied over the quadriceps will cause the heel to rise.
Preliminary results suggest almost 100% sensitivity and specificity of Lelli’s test.However, Valsalam et al (2020) found its sensitivity of 85.57%, specificity of 25.00%, PPV of 82.18%, NPV of 30.00%, and accuracy of 73.55%.
- Lelli A, Di Turi RP, Spenciner DB, Dòmini M. The “Lever Sign”: a new clinical test for the diagnosis of anterior cruciate ligament rupture. Knee Surgery, Sports Traumatology, Arthroscopy. 2016 Sep 1;24(9):2794-7.
- Pramod VK, Krishnan J, Shah I. Clinicoradiological and arthroscopic correlation of "lever sign test" in diagnosis of isolated anterior cruciate ligament rupture. International Journal of Scientific Research. 2020;9:1-2.
- Deveci A, Cankaya D, Yilmaz S, Özdemir G, Arslantaş E, Bozkurt M. The arthroscopical and radiological corelation of lever sign test for the diagnosis of anterior cruciate ligament rupture. Springerplus. 2015 Dec 1;4(1):830.
- Valsalam P, Sha I I, Edwin A. Lever Test: Role of Its Assistance in Diagnosis of Anterior Cruciate Ligament Injury. Journal of Research in Orthopedic Science. 2020 Aug 10;7(3):115-20.
- Jessica Keller. Positive Lelli's test! Available from: https://www.youtube.com/watch?v=44W5MER9IAA [last accessed 28 December 2020]