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Lever Sign Test

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Other Names

Lever Sign Test
  • Lever Sign Test
  • Lever Test
  • Lelli's Test


Illustration of how to perform the lever sign test[1]


  • The patient is supine, leg is fully extended on the examination table
    • If patient will tolerate, note effused knees are hard to extend
  • Examiner places a closed fist under the tibia at the level of the tibial tuberosity
    • This will cause the knee to flex slightly
  • With the other hand, the examiner places a downward pressure to the distal femur above the knee
    • This causes the fist to act as a lever
  • Normal test (intact ACL)
    • The patients foot will rise appropriately off the bed with the downward force
  • Positive test (ruptured ACL)
    • The patients foot will remain in contact with the bed with the addition of downward force



  • Lelli et al:[2]
    • Original authors who designed the exam
    • Sensitivity: 100%
  • Jarbo et al[1]
    • Sensitivity: 63%
    • Specificity: 90%

See Also


  1. 1.0 1.1 Jarbo, Keith A., et al. "Accuracy of the lever sign test in the diagnosis of anterior cruciate ligament injuries." Orthopaedic journal of sports medicine 5.10 (2017): 2325967117729809.
  2. 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 Surg Sports Traumatol Arthrosc. 2016 Sep;24(9):2794-2797.
Created by:
John Kiel on 1 February 2020 13:43:25
Last edited:
18 October 2023 18:43:48