Nontraumatic Knee Complaints in Adults in General Practice

In general practice, knee complaints (traumatic and nontraumatic) take second place after back pain in the prevalence of musculoskeletal disorders (19/1000 patients per year), mostly presented as knee pain or functional loss of the knee joint. Of these complaints, approximately 20% are traumatic. In spite of the high prevalence of knee complaints few studies have assessed the signs, symptoms and prognosis of nontraumatic knee complaints. Especially in general practice these data are scarcely available. The aim of this thesis was to provide more knowledge about the course and prognosis of nontraumatic knee complaints in adults in general practice. First, the cross-sectional and longitudinal validity of a performance-based assessment of knee function was determined in first-time consulters with nontraumatic knee complaints in general practice (GP). The validity of this test could not be demonstrated. Further, measurement instruments developed and validated in secondary care are therefore not automatically also valid in a primary care setting. In a systematic review to prognostic factors of progression of knee osteoarthritis (OA) the available evidence was summarized. After 1 year follow-up, 49% of the patients reported persistent knee complaints. Symptom characteristics were found the strongest predictors of persisting knee complaints at 1-year follow-up. Physical examination had no added value in predicting persistent knee symptoms in general practice. Also the ACR clinical classification criteria of knee OA had no prognostic value for predicting persisting knee complaints or an increase of disability at one year follow-up. Concerning medical treatment of the general practitioner, medical treatment at baseline partly corresponded with recommendations given in the Guideline of the Dutch College of General Practitioners for nontraumatic knee complaints in adults. Further, in this study group, medical consumption was relatively high during 1-year follow-up. Finally, the revised Dutch College of General Practitioners guideline for nontraumatic knee problems in adults is presented. This guideline is developed based on the available evidence in medical literature and recommendations for daily practice are provided.

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