Lever Sign (Lelli's Test) Special Test

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%

References

• Magee, D. J. (2021). Orthopedic Physical Assessment.