Assessing Medial Collateral Ligament Knee Lesions in General Practice

Purpose: To assess the diagnostic value of history-taking and physical examination of medial collateral ligament lesions after a knee injury presenting in general practice. Methods: Patients aged 18 to 65 years with a traumatic knee injury who consulted their general practitioner within 5 weeks after trauma filled out a questionnaire, underwent a standardized physical examination, and underwent a magnetic resonance imaging scan. Logistic regression analysis was used to test possible associations between determinants from history-taking/physical examination and medial collateral ligament lesions. The diagnostic value of history-taking and physical examination was determined for those variables indicating an association (P <.15) with medial collateral ligament lesions and was assessed by sensitivity, specificity, predictive value, and likelihood ratios. Results: Of the 134 patients included in this study, 35 had a medial collateral ligament lesion seen on magnetic resonance imaging scan. From history-taking, the determinants "trauma by external force to leg" and "rotational trauma" showed an association with medial collateral ligament lesion after multivariate analysis (P <.15). From physical examination, "pain valgus stress 30°" and "laxity valgus stress 30°" showed an association (P <.15). Isolated determinants from history-taking and physical examination showed some diagnostic value; the likelihood ratio positive was 2.0 for "trauma by external force to leg" and 2.3 for "pain valgus stress 30°." Adding "pain valgus stress 30°" and "laxity valgus stress 30°" from physical examination to history-taking improved the diagnostic value to a likelihood ratio positive of 6.4. Conclusion: Medial collateral ligament lesions are frequently seen in patients with traumatic knee injury. History-taking has a diagnostic value, while adding physical examination increases the diagnostic value. © 2008 Elsevier Inc. All rights reserved.

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