Diagnostic Value of History-taking and Physical Examination for Assessing Meniscal Tears of the Knee in General Practice

Wagemakers, Harry P. A.; Heintjes, Edith M.; Boks, Simone S.; Berger, Marjolein Y.; Verhaar, Jan A N; Koes, Bart W.; Bierma-Zeinstra, Sita M A

doi:10.1097/jsm.0b013e31815887a7

Cited by 57 publications

(46 citation statements)

References 33 publications

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“…11,16 The factor performing sports was a relevant risk e527 British Journal of General Practice, August 2015 …”

Section: 13mentioning

confidence: 99%

“…7,8,11 The following candidate predictors were collected: age, sex, BMI, origin of complaints, locked knee (yes/no), giving way, weight-bearing during trauma, performing sports, workrelated kneeling or squatting (>1 hour per day), ability to walk the stairs, effusion, warm knee, discolouration of the knee, pain during extension, and Deep Squat test. If a predictor was not interpretable or contradictive according to current knowledge, the predictor was excluded from the model.…”

Section: Predictors For Meniscal Tearsmentioning

confidence: 99%

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A clinical prediction rule for meniscal tears in primary care: development and internal validation using a multicentre study

et al. 2015

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BackgroundIn primary care, meniscal tears are difficult to detect. A quick and easy clinical prediction rule based on patient history and a single meniscal test may help physicians to identify high-risk patients for referral for magnetic resonance imaging (MRI). AimThe study objective was to develop and internally validate a clinical prediction rule (CPR) for the detection of meniscal tears in primary care. Design and settingIn a cross-sectional multicentre study, 121 participants from primary care were included if they were aged 18-65 years with knee complaints that existed for <6 months, and who were suspected to suffer from a meniscal tear. MethodOne diagnostic physical meniscal test and 14 clinical variables were considered to be predictors of MRI outcome. Using known predictors for the presence of meniscal tears, a 'quick and easy' CPR was derived. ResultsThe final CPR included the variables sex, age, weight-bearing during trauma, performing sports, effusion, warmth, discolouration, and Deep Squat test. The final model had an AUC of 0.76 (95% CI = 0.72 to 0.80). A cut-point of 150 points yielded an overall sensitivity of 86.1% and a specificity of 45.5%. For this cutpoint, the positive predictive value was 55.0%, and the negative predictive value was 81.1%. A scoring system was provided including the corresponding predicted probabilities for a meniscal tear. ConclusionThe CPR improved the detection of meniscal tears in primary care. Further evaluation of the CPR in new primary care patients is needed, however, to assess its usefulness.

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“…11,16 The factor performing sports was a relevant risk e527 British Journal of General Practice, August 2015 …”

Section: 13mentioning

confidence: 99%

Section: Predictors For Meniscal Tearsmentioning

confidence: 99%

A clinical prediction rule for meniscal tears in primary care: development and internal validation using a multicentre study

et al. 2015

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“…Many times, these meniscal tears are associated with degenerative change of the knee joint. [4][5][6][7] There are several common noncontact mechanisms for meniscal injury: a sudden change in direction while walking or running; forceful full flexion, such as squatting or arising from a squat position; or (for the older individual) a minor stress applied to the joint. Contact mechanisms in which varus, valgus, rotational, or hyperextension forces are applied to the knee and exceed the strength of the meniscus may produce longitudinal or transverse tears.…”

Section: Introductionmentioning

confidence: 99%

“…3,6,9 Historical evaluation that may raise suspicion for an underlying meniscus injury include the following: traumatic onset, with the knee hit from the side; nontraumatic onset, with weight-bearing on the knee and then twisting it; a pop at the time of injury; delayed swelling; a give-way sensation; and/or the knee painfully locks in one position. As the meniscus blends with the synovial lining of the joint capsule, a meniscal tear injury will apply a mechanical traction on the peripheral aspect, potentially producing inflammation of the synovial lining or a mechanical locking.…”

Section: Introductionmentioning

confidence: 99%

“…3,9,11,12 Information in the older individual as to status of degeneration of the knee and prior trauma is important. 6,13 Current evidence suggests that multiple assessment procedures during the physical examination increase the specificity and sensitivity and therefore diagnostic accuracy of identifying whether a patient has (or does not have) a medial meniscus lesion. 3,7,12,14 Joint line tenderness has been reported as an accurate assessment; in reality, by itself, it has only moderate diagnostic accuracy.…”

Section: Introductionmentioning

confidence: 99%

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Chiropractic management of a medial meniscus tear in a patient with tibiofemoral degeneration: a case report

Jarosz

Ames

2010

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe and discuss the clinical diagnosis of a medial meniscus tear in an older patient using a multimodal management approach provided by a chiropractor. Clinical Features: A 60-year-old woman reported to a chiropractic clinic with left knee pain and swelling. The history and physical examination findings suggested a medial meniscus tear, which was confirmed with magnetic resonance imaging. Intervention and Outcome: Treatment consisted of therapeutic ultrasound; rest, ice, compression, and elevation protocol; soft tissue therapy using effleurage and lymphatic drainage; chiropractic mechanically assisted adjusting techniques to the left knee using a handheld mechanical thrusting instrument; sports taping applied to assist facilitation of the vastus medialis obliquus; and a specific rehabilitation program aimed at strengthening this musculature. The patient's pain was assessed using a quadruple numeric pain scale. Function of the left knee was examined using McMurray, Apley, and a variation of Helfet orthopedic tests, as well as joint line tenderness. Monitoring was done at the initial consultation and at the sixth and 12th treatments. The patient reported being able to walk, swim, and ride a bicycle asymptomatically. Her pain score at the concluding visit was 16.7%, indicating low-intensity pain. Conclusion: This case indicated that conservative management of a meniscus tear through a chiropractic multimodal treatment approach provided an alternative or adjunctive therapy to routine orthopedic surgery for this patient.

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Clinical History for Knee Conditions

Charalambous

2021

The Knee Made Easy

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Diagnostic Value of History-taking and Physical Examination for Assessing Meniscal Tears of the Knee in General Practice

Abstract: History-taking has some diagnostic value, whereas physical examination did not add any diagnostic value for detecting meniscal tears in general practice.

Cited by 57 publications

References 33 publications

A clinical prediction rule for meniscal tears in primary care: development and internal validation using a multicentre study

A clinical prediction rule for meniscal tears in primary care: development and internal validation using a multicentre study

Chiropractic management of a medial meniscus tear in a patient with tibiofemoral degeneration: a case report

Clinical History for Knee Conditions

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