Décary Simon, Ouellet Philippe, Vendittoli Pascal-André, Roy Jean-Sébastien, Desmeules François
School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.
Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada; Department of Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada.
Phys Ther Sport. 2017 Jan;23:143-155. doi: 10.1016/j.ptsp.2016.08.002. Epub 2016 Aug 5.
More evidence on diagnostic validity of physical examination tests for knee disorders is needed to lower frequently used and costly imaging tests.
To conduct a systematic review of systematic reviews (SR) and meta-analyses (MA) evaluating the diagnostic validity of physical examination tests for knee disorders.
A structured literature search was conducted in five databases until January 2016. Methodological quality was assessed using the AMSTAR.
Seventeen reviews were included with mean AMSTAR score of 5.5 ± 2.3. Based on six SR, only the Lachman test for ACL injuries is diagnostically valid when individually performed (Likelihood ratio (LR+):10.2, LR-:0.2). Based on two SR, the Ottawa Knee Rule is a valid screening tool for knee fractures (LR-:0.05). Based on one SR, the EULAR criteria had a post-test probability of 99% for the diagnosis of knee osteoarthritis. Based on two SR, a complete physical examination performed by a trained health provider was found to be diagnostically valid for ACL, PCL and meniscal injuries as well as for cartilage lesions.
When individually performed, common physical tests are rarely able to rule in or rule out a specific knee disorder, except the Lachman for ACL injuries. There is low-quality evidence concerning the validity of combining history elements and physical tests.
为减少常用且昂贵的影像学检查，需要更多关于膝关节疾病体格检查诊断有效性的证据。
对评估膝关节疾病体格检查诊断有效性的系统评价（SR）和荟萃分析（MA）进行系统综述。
截至2016年1月，在五个数据库中进行了结构化文献检索。使用AMSTAR评估方法学质量。
纳入17篇综述，平均AMSTAR评分为5.5±2.3。基于6篇SR，单独进行时，仅前交叉韧带损伤的拉赫曼试验具有诊断有效性（似然比（LR+）：10.2，LR-：0.2）。基于2篇SR，渥太华膝关节规则是膝关节骨折的有效筛查工具（LR-：0.05）。基于1篇SR，欧洲抗风湿病联盟（EULAR）标准诊断膝关节骨关节炎的验后概率为99%。基于2篇SR，发现由训练有素的医疗服务提供者进行的全面体格检查对前交叉韧带、后交叉韧带和半月板损伤以及软骨损伤具有诊断有效性。
单独进行时，除了用于前交叉韧带损伤的拉赫曼试验外，常见的体格检查很少能够确诊或排除特定的膝关节疾病。关于结合病史要素和体格检查有效性的证据质量较低。
