Evaluating Medical Students' Competence in Orthopedic Special Tests for Diagnosing Anterior Cruciate Ligament (ACL) Injuries
DOI:
https://doi.org/10.35516/jmj.v60i1.4405Keywords:
Medical education, ACL injury, Orthopedic examination, Clinical skills, Learning curveAbstract
Background: Competence in physical examination is essential for medical students, particularly in musculoskeletal assessment. Anterior Cruciate Ligament (ACL) injuries are common and typically evaluated through a combination of clinical history, imaging, and physical tests. This study aimed to assess the ability of medical students from two medical schools to perform three commonly used ACL tests: Lachman’s test, anterior drawer test, and Lever sign (Lelli’s test).
Methods: In this cross-sectional study, 200 fifth-year medical students from two medical schools in Jordan participated during their orthopedic surgery rotations. Each student performed the Lachman’s, anterior drawer, and Lever sign tests on two patients with MRI-confirmed ACL tears and two healthy control subjects. Student performance was evaluated based on correct execution of each test. Comparisons were made between institutions and against a senior resident benchmark. A simulated learning curve model was also generated to illustrate progression across training levels.
Results: A total of 200 fifth-year medical students were evaluated. Correct test performance was highest for the Lever sign (92.0%), followed by the anterior drawer (85.5%) and Lachman’s test (81.5%). No significant differences were observed between students from the two institutions (p = 0.192–0.731). Performance was higher on control subjects compared to ACL-injured patients. Senior residents demonstrated superior performance across all tests: Lachman’s (p = 0.004), (p = 0.001), and Lever sign (p = 0.027). Simulated learning curves indicated higher AULC values for the Lever sign (281.5) compared to the anterior drawer (270.8) and Lachman’s test (263.8), suggesting differences in the relative ease of skill acquisition.
Conclusion: Medical students performed ACL special tests with varying success, reflecting the differing technical demands of each maneuver. The Lever sign was most consistently performed correctly, while the Lachman’s and anterior drawer tests showed lower performance compared to senior residents. Simulated learning curves emphasized skill acquisition differences, supporting the need for structured, progressive training to improve orthopedic examination competency.
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