Diagnostic value of history-taking and physical examination for assessing meniscal tears of the knee in general practice.

OBJECTIVE

To assess the diagnostic value of history-taking and physical examination of meniscal tears in general practice.

DESIGN

An observational study determining diagnostic values (sensitivity, specificity, predictive value, and likelihood ratios).

SETTING

General practice.

PATIENTS

Consecutive patients aged 18 to 65 years with a traumatic knee injury who consulted their general practitioner within 5 weeks after trauma.

ASSESSMENT

Participating patients filled out a questionnaire (history-taking) followed by a standardized physical examination.

MAIN OUTCOME

Assessment of meniscal tears was determined by means of magnetic resonance imaging (MRI) and was performed blinded for the results of physical examination and history-taking.

RESULTS

Of the 134 patients included in this study, 47 had a meniscal tear. From history-taking, the determinants "age over 40 years," "continuation of activity impossible," and "weight-bearing during trauma" indicated an association with a meniscal tear after multivariate logistic regression analysis, whereas from physical examination only "pain at passive flexion" indicated an association. These associated determinants from history-taking showed some diagnostic value; the positive likelihood ratio (LR+) reached up to 2.0 for age over 40 years, whereas the isolated test pain at passive flexion from physical examination has less diagnostic value, with an LR+ of 1.3. Combining determinants from history-taking and physical examination improved the diagnostic value with a maximum LR+ of 5.8; however, this combination only applied to a limited number of patients.

CONCLUSION

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