Diagnostic Validity of Combining History Elements and Physical Examination Tests for Traumatic and Degenerative Symptomatic Meniscal Tears

Décary, Simon; Fallaha, Michel; Frémont, Pierre; Martel‐Pelletier, Johanne; Pelletier, Jean‐Pierre; Feldman, Debbie; Sylvestre, Marie‐Pierre; Vendittoli, Pascal‐André; Desmeules, François

doi:10.1016/j.pmrj.2017.10.009

Cited by 6 publications

(4 citation statements)

References 60 publications

(101 reference statements)

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“…This was a multicentre, prospective, diagnostic cohort study of SOA patients aimed at developing a series of diagnostic support tools for common knee disorders. Several diagnostic clusters have been developed for other common knee disorders and have been published (Decary et al, a). In order to represent a wide spectrum of knee disorders and clinical presentations, we recruited prospective patients seeking care for an active knee complaint from two orthopaedic clinics, two primary care family medicine clinics and a university community between November 2014 and August 2016 (Decary, Fallaha, Fremont, et al, a).…”

Section: Methodsmentioning

confidence: 99%

“…Several diagnostic clusters have been developed for other common knee disorders and have been published (Decary et al, a). In order to represent a wide spectrum of knee disorders and clinical presentations, we recruited prospective patients seeking care for an active knee complaint from two orthopaedic clinics, two primary care family medicine clinics and a university community between November 2014 and August 2016 (Decary, Fallaha, Fremont, et al, a). The present study, its design, methodology and reporting of results conformed to the Standards for Reporting Diagnostic Accuracy Studies 2015 (STARD) (Bossuyt et al, ).…”

Section: Methodsmentioning

confidence: 99%

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Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis

Décary

Feldman

Frémont

et al. 2018

Musculoskeletal Care

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis

Décary

Feldman

Frémont

et al. 2018

Musculoskeletal Care

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“…Most recently, Décary et al ( 2018 ) looked at patients with traumatic or degenerative meniscal tear. Medial joint-line tenderness increased the likelihood of traumatic tear but not DMT.…”

Section: Practice Of Medicine and Diagnosismentioning

confidence: 99%

Arthroscopic partial meniscectomy: did it ever work?

2021

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Arthroscopic partial meniscectomy (APM) is one the most common orthopedic surgical procedures. The most common indication for APM is a degenerative meniscal tear (DMT). High-quality evidence suggests that APM does not provide meaningful benefits in patients with DMTs and may even be harmful in the longer term. This narrative review focuses on a fundamental question: considering the history and large number of these surgeries, has APM ever actually worked in patients with DMT? A truly effective treatment needs a valid disease model that would biologically and plausibly explain the perceived treatment benefits. In the case of DMT, effectiveness requires a credible framework for the pain-generating process, which should be influenced by APM. Basic research, pathoanatomy, and clinical evidence gives no support to these frameworks. Moreover, treatment of DMT with an APM does not align with the traditional practice of medicine since DMT is not a reliable diagnosis for knee pain and no evidence-based indication exists that would influence patient prognosis from APM. A plausible and robust explanation supported by both basic research and clinical evidence is that DMTs are part of an osteoarthritic disease process and do not contribute to the symptoms independently or in isolation and that symptoms are not treatable with APM. This is further supported by the fact that APM as an intervention is paradoxical because the extent of procedure and severity of disease are both inversely associated with outcome. We argue that arthroscopic treatment of DMT is largely based on a logical fallacy: post hoc ergo propter hoc.

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“…They can either be traumatic—associated with a knee injury, manifesting with sudden pain [ 4 ]—or result from age-related degenerative changes in the fibrocartilage tissue [ 5 ]. Such a distinction is usually made through a careful analysis of patients’ clinical history [ 6 ] and MRI patterns [ 7 ] and can also be confirmed on a histological level [ 8 ]. Degenerative meniscal lesions evolve slowly and present an age-related increase in prevalence [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews

et al. 2022

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Background Arthroscopic partial meniscectomy (APM) is widely applied for the treatment of degenerative meniscal lesions in middle-aged patients; however, such injury is often associated with mild or moderate osteoarthritis and has been reported by MRI in asymptomatic knees. Previous studies suggested, in most patients, a lack of benefit of surgical approach over conservative treatment, yet many controversies remain in clinical practice. Our aims were to assess the functional and pain scores between exercise therapy and arthroscopic surgery for degenerative meniscal lesions and to evaluate the methodological quality of the most recent systematic reviews (SRs). Methods Two authors independently searched PubMed and Google Scholar for SRs comparing the outcome (in knee pain and functionality) of arthroscopic treatment and exercise therapy or placebo for degenerative meniscal lesions. The timeframe set was from 2009 to 2019 included. Results A total of 13 SRs were selected. Two reviewers independently assessed the methodological quality of each paper using the AMSTAR 2 tool: seven scored as “moderate,” four obtained a “low” grade while the remaining two were evaluated as “critically low.” SRs agreed that in middle-aged patients with degenerative meniscal lesions arthroscopic surgery appears to grant no long-term improvement in pain and function over exercise therapy or placebo. Conclusions Conservative treatment based on physical therapy should be the first-line management. However, most SRs revealed subgroups of patients that fail to improve after conservative treatment and find relief when undergoing surgery. In the future, randomized controlled trials, evidence should be looked for that APM can be successful in case of the unsatisfactory results after physical therapy.

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Diagnostic Validity of Combining History Elements and Physical Examination Tests for Traumatic and Degenerative Symptomatic Meniscal Tears

Abstract: I.

Cited by 6 publications

References 60 publications

Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis

Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis

Arthroscopic partial meniscectomy: did it ever work?

Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews

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