The accuracy of the clinical knee examination documented by arthroscopy

Abstract

The diagnostic accuracy of the clinical examination for intraarticular injuries of the knee was documented by arthroscopy over a 6-month period. Two-hundred ninety patients (296 knees) were evaluated by history, physical examination, and standard radiographs. Supplemental diagnostic studies included 41 magnetic resonance images, 2 arthrograms, and 1 previous arthroscopy that had been recently performed. Overall, the correct diagnosis was made in 165 knees (56%), an incomplete diagnosis in 92 (31%), and an incorrect diagnosis in 39 (13%). There were only 2 knees (0.07%) with no discernable lesions. When a single lesion was present in the knee, the diagnosis was made correctly in 72% of cases. When more than 2 were discovered, the diagnosis was correct in only 30%. However, all individual lesions were diagnosed with an accuracy of greater than 90%. The lesions most difficult to diagnose were chondral fractures, fibrotic fat pads, tears in the anterior cruciate ligament, and loose bodies. Knees with acute lesions and those with a single diagnosis proved to be significantly easier to diagnose (P < 0.01). The variables that proved to be insignificant were age, sex, magnetic resonance imaging, surgeon, workers' compensation, or pending litigation.

Clinical Diagnosis of an Anterior Cruciate Ligament Rupture: A Meta-analysis

“…Five of the 21 studies did not specify the diagnostic accuracy per test but commented on the composite clinical examination for ligamentous injuries. 36,53,54,58,64 These articles did not include data for specific clinical or surgical examination. Studies that described the diagnostic accuracy of measuring anterior laxity by instruments, such as the KT-1000, were also excluded.…”

“…Our results show that the test has unacceptable low sensitivity and specificity for use in the clinical setting, especially in acute condition (49% [95% CI, [43][44][45][46][47][48][49][50][51][52][53][54][55] and 58% [95% CI, 39-76], respectively). Torg et al 72 noted 3 possible causes for a false-negative anterior drawer test in acute condition, especially in isolated ACL tears.…”

“…However, these were just minor changes certainly not clinically relevant. More specifically, when we look at the performance of the tests without anesthesia, the greatest difference was for the anterior drawer test, which showed a pooled sensitivity of 49% (95% CI, [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] for the studies with highest quality, 9,18,39,50,52,69 compared to 56% (95% CI, 53-59) for the rest of the studies with lower quality. However, this difference is not clinically relevant, as both estimates are too low to be acceptable for the use of this test in clinical setting.…”

Stress Radiography for the Diagnosis of Knee Ligament Injuries: A Systematic Review

“…Clinician experience, a patient's pain, tolerance of the examination, and concurrent ligamentous injuries may skew physical examination interpretation, detracting in certain situations from its clinical use [22,25,27]. Previously reported discrepancies in the reliability and reproducibility of the physical examination have created a niche for objective and quantifiable assessments of ligament stability such as stress radiography that augment diagnostic power and enhance management decisionmaking [33,35,36].…”

Validity of the McMurray's Test and Modified Versions of the Test: A Systematic Literature Review

“…Thus, to avoid selection bias, it is important that a study include consecutive patients with pathologies that could be commonly confused with a meniscal tear and should not include patients without symptoms. The inclusion of patients with multiple pathologies is likely to lessen the diagnostic accuracy of a test; however, this would reflect actual clinical practice 6,18 . Six of the studies within this review included consecutive patients (Table 4).…”