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


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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    • "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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