Does This Patient Have a Torn Meniscus or Ligament of the Knee?

Department of Orthopedic Surgery, The Cleveland Clinic, 9500 Euclid Ave, Desk A41, Cleveland, OH 44195, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 11/2001; 286(13):1610-20. DOI: 10.1001/jama.286.13.1610
Source: PubMed

ABSTRACT ment, using the anterior drawer test, were 3.8 (95% confidence interval (CI), 0.7-22.0) for a positive examination and 0.30 (95% CI, 0.05-1.50) for a negative examination; the Lachman test, 25.0 (95% CI, 2.7-651.0) and 0.1 (95% CI, 0.0-0.4); and the com- posite assessment, 25.0 (95% CI, 2.1-306.0) and 0.04 (95% CI, 0.01-0.48), respec- tively. The LRs could not be generated for any specific examination maneuver for a pos- terior cruciate ligament tear, but the composite assessment had an LR of 21.0 (95% CI, 2.1-205.0) for a positive examination and 0.05 (95% CI, 0.01-0.50) for a negative exami- nation. Determination of meniscal lesions, using McMurray test, had an LR of 1.3 (95% CI, 0.9-1.7) for a positive examination and 0.8 (95% CI, 0.6-1.1) for a negative exami- nation; joint line tenderness, 0.9 (95% CI, 0.8-1.0) and 1.1 (95% CI, 1.0-1.3); and the composite assessment, 2.7 (95% CI, 1.4-5.1) and 0.4 (95% CI, 0.2-0.7), respectively. Conclusion The composite examination for specific meniscal or ligamentous inju- ries of the knee performed much better than specific maneuvers, suggesting that syn- thesis of a group of examination maneuvers and historical items may be required for adequate diagnosis.

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Available from: David W Bates, Sep 27, 2015
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    • "Currently the two main methods of accurately diagnosing an ACL tear are physical examination and MRI scanning. It is a common misconception that an accurate assessment of a knee ligament tear requires a magnetic resonance image (MRI) [2]. Studies have shown that a trained expert can diagnose an ACL tear with about 90% accuracy through a physical examination [3] [4]. "
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    ABSTRACT: An anterior cruciate ligament (ACL) tear is one of the most prominent, and debilitating injuries currently to athletes. Physical therapist students need to be able to practice common physical examination techniques regularly and repeatedly in order to gain the skills necessary to accurately diagnose an ACL tear. A cost effective, adjustable knee apparatus that could mimic the behavior of both a healthy and an injured knee joint may mitigate this problem. We built an apparatus mimicking the geometry and function of a knee joint, including the effect of forces and stiffness proper of knee ligaments. SimWise 4D was used to dynamically simulate an anatomically approximated model of the knee joint during physical examination conditions. The numerical simulation tested the displacement between the femur and the tibia with and without an ACL ligament. The SimWise 4D simulation gave an increase in displacement of 1.58 mm or 30% after removing the ACL, which is comparable with known displacements in human test subjects. Finally, a design for a 3D rapid prototype is proposed and fabricated with fusion deposition modeling (FDM).
    Proceedings of the ASME 2015 International Mechanical Engineering Congress & Exposition; 11/2015
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    • "Then, the experimenter placed one hand on the patella and instructed the subject to contract the quadriceps femoris muscle while he pushed down on the patella. If pain was felt while performing this action, the subject tested positive8). For the eccentric step test, the subjects stood barefoot on a 15 cm high step. "
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    ABSTRACT: [Purpose] The purpose of this study was to evaluate the correlation between intrinsic patellofemoral pain syndrome (PFPS) in young adults and lower extremity biomechanics. [Subjects] This experiment was carried out with sixty (24 men and 32 women), who are normal university students as subjects. [Methods] All subjects underwent 3 clinical evaluations. For distinguishing the intrinsic PFPS from controls, we used the Modified Functional Index Questionnaire (MFIQ), Clarke's test and the Eccentric step test. Based on the results of the tests, subjects who were classified as positive for 2 more tests were allocated to the bilateral or unilateral intrinsic PFPS group (n=14), and the others were allocated to the control group (n=42). These two groups were tested for hamstring tightness, foot overpronation, and static Q-angle and dynamic Q-angle. These are the four lower extremity biomechanic, cited as risk factors of patellofemoral pain syndrome. [Results] The over pronation, static Q-angle and the dynamic Q-angle were not significantly different between the two groups. However, the hamstring tightness of the PFPS group was significantly greater than that of the controls. [Conclusion] We examined individuals for intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. We found a strong correlation between intrinsic PFPS and hamstring tightness.
    Journal of Physical Therapy Science 07/2014; 26(7):961-4. DOI:10.1589/jpts.26.961 · 0.39 Impact Factor
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    • "The Lachman test is the most valid stability test at the physical examination of the knee, with a sensitivity of 85% and a specificity of 95% (Solomon et al. 2001, Scholten et al. 2003, Benjaminse et al. 2006). Performance of a complete physical examination of the knee (Lachman test, pivot shift, anterior drawer test) has a higher sensitivity and specificity than a partial investigation (Solomon et al. 2001). MRI is a valid and safe non-invasive diagnostic tool for diagnosing anterior cruciate ligament injury, with a high sensitivity and specificity (both 94%) (Oei et al. 2003, Crawford et al. 2007). "
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    ABSTRACT: The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the "Appraisal of Guidelines for Research and Evaluation" instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice.
    Acta Orthopaedica 08/2012; 83(4):379-86. DOI:10.3109/17453674.2012.704563 · 2.77 Impact Factor
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