Clinical research study
Assessing Medial Collateral Ligament Knee Lesions in General Practice

https://doi.org/10.1016/j.amjmed.2008.05.041Get rights and content

Abstract

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.

Section snippets

Design

The present prospective, observational cohort study is part of the research network HONEUR (40 general practitioners) established by the department of General Practice of Erasmus Medical Center Rotterdam.13 New complaints were defined as episodes of complaints presented to the general practitioner for the first time.

Patients were eligible for the present study if they were aged 18 to 65 years and had consulted their general practitioner for a traumatic knee complaint within 5 weeks after the

Study Population

Of the 184 eligible patients, 134 (73%) were included in the present study (March 2002 to October 2003). The Figure shows the flowchart of eligible patients. Reasons for nonparticipation were unwillingness or missing appointments for the MRI (n = 21), no availability of MRI appointment (n = 14), and other reasons (n = 15). No patient was excluded because of the MRI exclusion criteria.

No statistically significant (P <.05) differences were found between the baseline characteristics of the participants

Discussion

The present study is the first to investigate the diagnostic value of history-taking and physical examination in patients with a MCL lesion in a primary care setting. In this study, MCL lesions were seen in 26% of the 134 included patients.

There is limited literature available on the diagnostic value of history-taking and physical examination of MCL lesions.11 The study by Rasenberg et al12 reported on MCL lesions, but concerned patients in secondary care. They concluded that there is a very

Conclusions

Based on history-taking and physical examination, the general practitioner can reasonably diagnose the absence of a MCL lesion. Our study shows that a general practitioner also can predict the existence of a MCL lesion with a maximum of 63% certainty, therefore, he cannot be completely certain whether there is a MCL lesion. Clinically, this may not be a problem, because the treatment of a MCL lesion initially consists of conservative treatment. If complaints persist, further diagnostic testing

Acknowledgements

The research network HONEUR is financially supported by the health insurance companies TRIAS, Zilveren Kruis Achmea, and OZ.

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