Clinical research studyAssessing Medial Collateral Ligament Knee Lesions in General Practice
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.
References (28)
- et al.
Grading medial collateral ligament injury: comparison of MR imaging and instrumented valgus-varus laxity test-deviceA prospective double-blind patient study
Eur J Radiol
(1995) - et al.
Imaging in sports-medicine—knee
Eur J Radiol
(1997) - et al.
Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijkKlachten en aandoeningen in de bevolking en in de huisartspraktijk
(2004) - et al.
Physical examination and imaging of the medial collateral ligament and posteromedial corner of the knee
Sports Med Arthrosc
(2006) - et al.
Magnetic resonance imaging abnormalities in symptomatic and contralateral knees: prevalence and associations with traumatic history in general practice
Am J Sports Med
(2006) - et al.
Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijkHuisartsenzorg: wat doet de poortwachte
(2004) - et al.
Evaluation of patients presenting with knee pain: part IHistory, physical examination, radiographs, and laboratory tests
Am Fam Physician
(2003) - et al.
The diagnosis of knee motion limits, subluxations, and ligament injury
Am J Sports Med
(1991) - et al.
The accuracy of the clinical knee examination documented by arthroscopyA prospective study
Am J Sports Med
(1993) - et al.
The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis
J Fam Pract
(2001)
Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis
J Fam Pract
Evaluation of acute knee pain in primary care
Ann Intern Med
The rational clinical examinationDoes this patient have a torn meniscus or ligament of the knee? Value of the physical examination
JAMA
Knee disorders in primary care: design and patient selection of the HONEUR knee cohort
BMC Musculoskelet Disord
Cited by (35)
Hip and Knee Injuries
2020, Primary Care - Clinics in Office PracticeCitation Excerpt :These injuries can occur alone, but also can occur with a meniscal tear or an ACL or PCL tear. Patients typically report localized swelling or stiffness along the medial aspect of the, knee but do not report instability or mechanical symptoms, such as locking or popping, which are typically found in cruciate ligament or meniscal injuries.60 The MCL may be tender along its entire course, from the medial femoral condyle to its insertion on the proximal tibia.
Diagnostic Value of Stress Radiography and Arthrometer Measurement for Anterior Instability in Anterior Cruciate Ligament Injured Knees at Different Knee Flexion Position
2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryDiagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis
2017, Physical Therapy in SportCitation Excerpt :Our review also shows that when clinical prediction rules are developed they may become useful, valid tools for the diagnosis of common knee disorders such as OA and fractures. Of interest, several clinical prediction rules have been developed in recent publications not presented in the included reviews (Cook et al., 2010; Kastelein et al., 2008, 2009; Wagemakers et al., 2008; Wagemakers et al., 2010) and demonstrated that the combination of specific history elements and physical tests have improved the diagnostic validity compared to individual tests for specific knee disorders. We believe that more methodologically sound diagnostic studies are needed and should focus on the evaluation of the clinical prediction rules that incorporate well-defined and specific history elements and physical tests.
Injury to the posterolateral corner of the knee: Emergency department assessment and management
2015, International Emergency NursingCitation Excerpt :Movement is performed within the confines of the patient's pain. Active, passive and resisted movements which comprise of flexion, extension and straight leg raise should be tested (Bickley, 2009; Kastelein et al., 2008). A number of specific knee examination tests are critical to the initial evaluation of the acute knee injury.
Optimized retrieval of primary care clinical prediction rules from MEDLINE to establish a web-based register
2011, Journal of Clinical Epidemiology