Diagnostic accuracy of clinical examination for ACL injury. Legend: Risk of bias judgements: (−) = high risk; (?) = unclear risk; (+) = low risk. LR thresholds: +LR <5 and -LR >0.2 = small; +LR 5–10 and; −LR 0.1–0.2 = moderate and +LR >10 and –LR <1 = large. Studies that reported estimates for complete ACL injury as well as partial and complete ACL injury estimates have been plotted together to provide a comparison of test performance. Different symbols are used for the estimates for complete versus partial and complete ACL injury and for primary care versus secondary contact settings. *joint effusion 2 hours; †joint effusion 12 hours; ‡immediate pain at trauma; §pain none to slight; ||pain moderate to severe; ¶guarded or painful ROM 24 hours after injury. Guide for interpretation: Greater distance between the –LR and +LR symbols for the test indicates better diagnostic performance.