Lowery Douglas J, Farley Timothy D, Wing David W, Sterett William I, Steadman J Richard
Orthopaedic Associates, Evansville, Indiana, USA.
Arthroscopy. 2006 Nov;22(11):1174-9. doi: 10.1016/j.arthro.2006.06.014.
Five common tests were used to diagnose meniscal tears when used as a composite score. We evaluated how effectively the composite examination, when performed in the presence of an anterior cruciate ligament (ACL) injury or degenerative joint disease (DJD), determined the presence of meniscal tears.
Data were collected prospectively on all patients at our clinic with a primary knee complaint. Independent variables included the presence or absence of the following: (1) a history of "catching" or "locking" as reported by the patient, (2) pain with forced hyperextension, (3) pain with maximum flexion, (4) pain or an audible click with McMurray's maneuver, and (5) joint line tenderness to palpation. Comprehensive patient demographic data were collected including ligamentous examinations and other intra-articular pathologies found at arthroscopy. Composite examination findings were correlated with the presence or absence of meniscal pathology.
We evaluated 635 knees in 576 patients for historical and physical findings. Of the knees, 209 underwent arthroscopic surgery and 426 did not. Chi(2) Analysis showed a significant relation between the number of positive diagnostic tests and the presence of meniscal tears (P = .001). Five positive findings on composite examination yielded a positive predictive value of 92.3%. Positive predictive values remained greater than 75% with composite scores of at least 3 in the absence of ACL and DJD pathologies. The presence of an ACL injury decreased the positive predictive value of 5 composite findings to 67%, whereas the presence of DJD increased predictability to 100%.
When all 5 symptoms and signs were positive, there was a 92.3% positive predictive value of finding a meniscal tear. Although positive predictive values decreased with a concomitant ACL injury and increased with DJD, there was a higher rate of false-positive findings (ACL) and false-negative findings (DJD).
Level II, development of diagnostic criteria with consecutive patients and gold standard.
将五项常见检查作为综合评分用于诊断半月板撕裂。我们评估了在前交叉韧带（ACL）损伤或退行性关节病（DJD）存在的情况下进行综合检查时，确定半月板撕裂存在的有效性。
前瞻性收集我们诊所所有以膝关节为主诉的患者的数据。自变量包括以下情况的有无：（1）患者报告的“卡顿”或“绞锁”病史，（2）强迫性过伸时的疼痛，（3）最大屈曲时的疼痛，（4）麦氏试验时的疼痛或可闻及的弹响，以及（5）关节线触压痛。收集了全面的患者人口统计学数据，包括韧带检查和关节镜检查中发现的其他关节内病变。综合检查结果与半月板病变的有无相关。
我们评估了576例患者的635个膝关节的病史和体格检查结果。其中209个膝关节接受了关节镜手术，426个未接受。卡方分析显示阳性诊断检查的数量与半月板撕裂的存在之间存在显著关系（P = 0.001）。综合检查五项阳性结果的阳性预测值为92.3%。在没有ACL和DJD病变的情况下，综合评分至少为3时，阳性预测值仍大于75%。ACL损伤的存在将五项综合检查结果的阳性预测值降至67%，而DJD的存在则将预测性提高到100%。
当所有五项症状和体征均为阳性时，发现半月板撕裂的阳性预测值为92.3%。虽然阳性预测值在伴有ACL损伤时降低，在DJD时升高，但假阳性结果（ACL）和假阴性结果（DJD）的发生率较高。
二级，采用连续患者和金标准制定诊断标准。
