Knee
ACL & PCL
Evidence: confirmed
Lever Sign (Lelli's Test) Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Diagnosing Anterior Cruciate Ligament (ACL) rupture.
- Effective even in patients with large legs or acute guarding.
How to Perform
- Position: Patient lies supine with legs straight.
- Setup: Examiner places a fist under the proximal calf (acting as a fulcrum).
- Action: Examiner pushes down firmly on the distal quadriceps (thigh).
Interpretation of Results
- Negative (Normal): The heel lifts off the table (the ACL pulls the tibia up).
- Positive (Rupture): The heel remains on the table (the tibia slides anteriorly instead of lifting the foot).
Diagnostic Accuracy
- Sensitivity: 94-100%
- Specificity: 98-100%
Clinical Context & Limitations
The Lever Sign (Lelli's Test) should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Knee region, combining the Lever Sign (Lelli's Test) with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment.
