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Lever Test

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Lever Sign Test
Illustration of how to perform the lever sign test[1]
(A) A photograph of the lever test setup, with the examiner's hand positioned for the test. (B) A photograph of a negative lever test, with the femur being translated posteriorly using the right hand (downward red arrow) and levering of the tibia resulting in lift-off of the heel (upward red arrow). The examiner's fist is just distal to the tibia tubercle. (C) A photograph of a positive lever test, with the femur being translated posteriorly using the left hand (downward red arrow) and translation of the proximal tibia anteriorly (white upward arrow) with no heel lift-off.[2]
This figure expresses two diagrams that demonstrate the lever sign test, with A indicating a positive test while B represents a normal exam.[3]
  • Lever Sign Test
  • Lever Test
  • Lelli's Test
  • Lelli Test
  • Lelli Sign
  • Lever Sign Test
  • Anterior Cruciate Ligament Lever Test

Purpose

Description

  • 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

Pathology

Evidence

ACL Injury

  • Lelli et al:[5]
    • Original authors who designed the exam
    • Sensitivity: 100%
  • Jarbo et al[1]
    • Sensitivity: 63%
    • Specificity: 90%

See Also

References

  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. ↑ Massey, Patrick A., et al. "Critical analysis of the lever test for diagnosis of anterior cruciate ligament insufficiency." Arthroscopy: The Journal of Arthroscopic & Related Surgery 33.8 (2017): 1560-1566.
  3. ↑ Hu, Shiqiang, et al. "Lever sign test for anterior cruciate ligament injuries: a diagnostic meta-analysis." Journal of orthopaedic surgery and research 19.1 (2024): 155.
  4. ↑ Lelli, Alessandro, et al. "The “Lever Sign”: a new clinical test for the diagnosis of anterior cruciate ligament rupture." Knee surgery, sports traumatology, arthroscopy 24.9 (2016): 2794-2797.
  5. ↑ 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
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Last edited:
25 January 2026 14:25:50
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