Diagnostic value of history-taking and physical examination for assessing meniscal tears of the knee in general practice
OBJECTIVE: To assess the diagnostic value of history-taking and physical examination of meniscal tears in general practice. DESIGN: An observational study determining diagnostic values (sensitivity, specificity, predictive value, and likelihood ratios). SETTING: General practice. PATIENTS: Consecutive patients aged 18 to 65 years with a traumatic knee injury who consulted their general practitioner within 5 weeks after trauma. ASSESSMENT: Participating patients filled out a questionnaire (history-taking) followed by a standardized physical examination. MAIN OUTCOME: Assessment of meniscal tears was determined by means of magnetic resonance imaging (MRI) and was performed blinded for the results of physical examination and history-taking. RESULTS: Of the 134 patients included in this study, 47 had a meniscal tear. From history-taking, the determinants "age over 40 years," "continuation of activity impossible," and "weight-bearing during trauma" indicated an association with a meniscal tear after multivariate logistic regression analysis, whereas from physical examination only "pain at passive flexion" indicated an association. These associated determinants from history-taking showed some diagnostic value; the positive likelihood ratio (LR+) reached up to 2.0 for age over 40 years, whereas the isolated test pain at passive flexion from physical examination has less diagnostic value, with an LR+ of 1.3. Combining determinants from history-taking and physical examination improved the diagnostic value with a maximum LR+ of 5.8; however, this combination only applied to a limited number of patients. CONCLUSION: History-taking has some diagnostic value, whereas physical examination did not add any diagnostic value for detecting meniscal tears in general practice.
|Keywords||*Family Practice, *Medical History Taking, *Physical Examination, Adult, Female, Humans, Knee Injuries/*diagnosis, Male, Menisci, Tibial/*injuries, Middle Aged, Netherlands, Prospective Studies|
|Persistent URL||dx.doi.org/10.1097/JSM.0b013e31815887a7, hdl.handle.net/1765/15186|
Wagemakers, H.P.A., Heintjes, E.M., Boks, S.S., Berger, M.Y., Verhaar, J.A.N., Koes, B.W., & Bierma-Zeinstra, S.M.. (2008). Diagnostic value of history-taking and physical examination for assessing meniscal tears of the knee in general practice. Clinical Journal of Sport Medicine, 18(1), 24–30. doi:10.1097/JSM.0b013e31815887a7