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

Solomon, Daniel H.; Simel, David L.; Bates, David W.; Katz, Jeffrey N.; Schaffer, Jonathan

doi:10.1001/jama.286.13.1610

Cited by 216 publications

(53 citation statements)

References 44 publications

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“…Most existing reviews evaluating the accuracy of tests to diagnose ACL injury [6,[11][12][13][14] are now over a decade old and contain methodological limitations such as inclusion of inappropriate studies and pooling of estimates from heterogeneous studies. Since these reviews were published there has been much progress in the diagnostic field with regard to study appraisal and synthesis [15].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review

et al. 2014

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Background: Numerous clinical tests are used in the diagnosis of anterior cruciate ligament (ACL) injury but their accuracy is unclear. The purpose of this study is to evaluate the diagnostic accuracy of clinical tests for the diagnosis of ACL injury. Methods: Study Design: Systematic review. The review protocol was registered through PROSPERO (CRD42012002069). Electronic databases (PubMed, MEDLINE, EMBASE, CINAHL) were searched up to 19th of June 2013 to identify diagnostic studies comparing the accuracy of clinical tests for ACL injury to an acceptable reference standard (arthroscopy, arthrotomy, or MRI). Risk of bias was appraised using the QUADAS-2 checklist. Index test accuracy was evaluated using a descriptive analysis of paired likelihood ratios and displayed as forest plots. Results: A total of 285 full-text articles were assessed for eligibility, from which 14 studies were included in this review. Included studies were deemed to be clinically and statistically heterogeneous, so a meta-analysis was not performed. Nine clinical tests from the history (popping sound at time of injury, giving way, effusion, pain, ability to continue activity) and four from physical examination (anterior draw test, Lachman's test, prone Lachman's test and pivot shift test) were investigated for diagnostic accuracy. Inspection of positive and negative likelihood ratios indicated that none of the individual tests provide useful diagnostic information in a clinical setting. Most studies were at risk of bias and reported imprecise estimates of diagnostic accuracy. Conclusion: Despite being widely used and accepted in clinical practice, the results of individual history items or physical tests do not meaningfully change the probability of ACL injury. In contrast combinations of tests have higher diagnostic accuracy; however the most accurate combination of clinical tests remains an area for future research. Clinical relevance: Clinicians should be aware of the limitations associated with the use of clinical tests for diagnosis of ACL injury.

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Section: Introductionmentioning

confidence: 99%

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review

et al. 2014

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“…The Lachman test is the ''gold standard'' physical exam assessment for ACL disruption, and is more sensitive than the Anterior Drawer test as menisci and condylar containment are not as much a factor in 30°of flexion [30][31][32][33][34]. Increased tibial excursion without an end point indicates ACL disruption.…”

Section: Physical Examinationmentioning

confidence: 99%

ACL Injury and Rehabilitation

Laskowski

2013

Curr Phys Med Rehabil Rep

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The anterior cruciate ligament (ACL) is a primary restraint to anterior tibial translation and a significant contributor to both static and dynamic knee stability, especially for sports and activities that require deceleration and aggressive cutting and pivoting movements. ACL injuries have a significant impact on individual function and on the health care economy, and continue to be prevalent and disproportionate, affecting more women than men. Factors have been identified which can help predict success in non-operative treatment, and surgical procedures have advanced to the point of ensuring a reliable outcome with respect to joint stability. Rehabilitation interventions focus on enhancing lower extremity strength, stability, and neuromuscular control. Both operative and nonoperative treatment options, however, have been associated with an increased risk of later osteoarthritis. ACL prevention programs have attempted to correct flaws in movement patterns and neuromuscular control, but long-term data on the efficacy of these programs and of specific interventions are lacking.

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“…Devido a estas fortes fixações e às grandes forças que são transmitidas no compartimento medial do joelho, o menisco medial é mais susceptível à lesões (SOLOMON et al, 2001;MCCARTY et al, 2002). É uma fibrocartilagem essencial para o dinamismo do joelho e sua lesão determina o funcionamento anormal da articulação, predispondo a ocorrência de osteoartrite (BAVARESCO, 2003).…”

Section: Introductionunclassified

“…Na rotação externa ocorre o movimento inverso, ou seja, acompanham o movimento do fêmur. Isto ocorre devido à ação de tracionamento dos ligamentos patelares e à pressão que o fêmur exerce sobre os meniscos (KAPANDJI, 1990;SOLOMON et al, 2001). Durante a flexão, os meniscos são tracionados caudalmente e durante a extensão cranialmente, conforme suas inserções.…”

Section: Introductionunclassified

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Propriedades mecânicas de meniscos frescos de coelhos e preservados em glicerina 98%

et al. 2010

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

Abstract: The composite examination for specific meniscal or ligamentous injuries of the knee performed much better than specific maneuvers, suggesting that synthesis of a group of examination maneuvers and historical items may be required for adequate diagnosis.

Cited by 216 publications

References 44 publications

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review

ACL Injury and Rehabilitation

Propriedades mecânicas de meniscos frescos de coelhos e preservados em glicerina 98%

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