Knee Orthopaedic Test: Lever Sign Test

The Lever Sign Test is a physical examination maneuver used to diagnose anterior cruciate ligament (ACL) injuries in the knee. Here are the steps to perform the Lever Sign Test:

1. Ask the patient to lie flat on their back with their legs straight.
2. Bend the patient's affected knee to a 90-degree angle.
3. Place your hands on the patient's upper tibia and lower femur to stabilize the knee joint.
4. With your other hand, grasp the patient's heel and pull it towards their buttocks, while pushing the patient's thigh downwards.
5. Observe the movement of the tibia in relation to the femur.
6. A positive Lever Sign Test is indicated by anterior tibial translation or movement of the tibia forward in relation to the femur. This indicates a possible ACL injury.

References:

1. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2007 Nov;37(11):541-50. doi: 10.2519/jospt.2007.2337. PMID: 18021597.
2. Kopkow C, Freiberg A, Kirschner S, et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for medial meniscus posterior horn tears. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):1525-1531. doi:10.1007/s00167-016-4358-1
3. Magee, D. J. (2018). Orthopedic physical assessment. Elsevier Health Sciences.