Execution:
- Patient is in supine lying position
- The examiner makes a fist and places it under the proximal 1/3 of the calf on the leg to be tested
- With the other hand, the examiner applies a moderate downward force on the distal part of the femur
Positive Outcome: If the patient’s heel does not rise off of the table, a partial or complete ACL tear is suspected
| Study |
Reliability |
Sn | Sp | LR+ |
LR- |
| Lelli et al. (2014) |
NA |
100 | 100 | ∞ |
0 |
| Jarbo et al. (2017) |
NA |
63 | 90 | 6.3 |
0.41 |
| Mulligan et al. (2017) |
NA |
37 | 72 | 1.32 |
0.88 |
| Gürpınar et al. (2019) |
Inter-rater ĸ=0.78 |
91.9 | 93.8 | 14.82 |
0.09 |
| Massey et al. (2017) |
NA |
82 | 80 | 4.15 |
0.21 |
| Huang et al. (2022) |
NA |
79 (75-83) | 91 (87-95) | 9.56 (2.76-33.17) |
0.23 (0.12-0.46) |
| Tanaka et al. (2022) |
NA |
82 (76-87) | 88 (82-93) | 6.49 (3.92-10.73) |
0.21 (0.11-0.40) |
| Sokal et al. (2022) |
NA |
83 (68-92) |
91 (83-95) |
9.66 (0.01-17.3) |
0.19 |
| Comment: With the exception of the results by Jarbo et al. (2017) and Mulligan, the Lever Sign shows good accuracy to confirm and rule out ACL tears | |||||
