Gilat Ron, Mitchnik Ilan Y, Moriah Assaf, Levi Almog, Cohen Ornit, Lindner Dror, Beer Yiftah, Agar Gabriel
Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel.
Int Orthop. 2022 Apr;46(4):831-836. doi: 10.1007/s00264-021-05277-x. Epub 2022 Jan 7.
Obesity is a worldwide pandemic; however, no adaptations were made to the physical examination of obese patient's knees. The accuracy of the physical examination is critical for correct assessment and selection of treatment. We aimed to assess whether body mass index (BMI) affects the sensitivity and specificity of common provocative knee tests.
We studied 210 patients who underwent knee arthroscopy to treat anterior cruciate ligament (ACL) and meniscal pathologies. BMI and the knee's physical examination were documented pre-operatively. Sensitivity, specificity, and accuracy of ACL and meniscal provocative tests in relation to BMI were evaluated using arthroscopy as a gold standard.
The Anterior Drawer, Lachman, and Pivot-Shift tests for ACL tears were significantly less accurate and sensitive, yet more specific, in obese patients when compared to normal and overweight patients. The McMurray, Apley Grind, and Thessaly tests for medial meniscus tears showed greater sensitivity, but lower specificity, in patients with increased BMI. Above normal BMIs, independently of age and gender, were significantly associated with higher odds for positive ACL tests.
Tests for ACL tears are less sensitive in obese patients and alternatives to the classic tests should be considered. Medial meniscus tests tend to be more sensitive and less specific in patients with greater BMIs. Their results should be carefully interpreted due to possible false positives. The physician should take into consideration the impact of patient BMI on the accuracy of their physical examination of the knee to optimize treatment decision-making.
肥胖是一种全球性的流行病；然而，对于肥胖患者膝关节的体格检查并未进行调整。体格检查的准确性对于正确评估和选择治疗方法至关重要。我们旨在评估体重指数（BMI）是否会影响常见膝关节激发试验的敏感性和特异性。
我们研究了210例接受膝关节镜检查以治疗前交叉韧带（ACL）和半月板病变的患者。术前记录BMI和膝关节的体格检查情况。以关节镜检查作为金标准，评估ACL和半月板激发试验相对于BMI的敏感性、特异性和准确性。
与正常体重和超重患者相比，肥胖患者中ACL撕裂的前抽屉试验、拉赫曼试验和轴移试验的准确性和敏感性显著降低，但特异性更高。对于内侧半月板撕裂，麦克马瑞试验、阿普利研磨试验和 Thessaly试验在BMI增加的患者中显示出更高的敏感性，但特异性较低。高于正常的BMI，独立于年龄和性别，与ACL试验阳性的较高几率显著相关联。
肥胖患者中ACL撕裂的试验敏感性较低，应考虑经典试验的替代方法。内侧半月板试验在BMI较高的患者中往往更敏感但特异性较低。由于可能出现假阳性，其结果应谨慎解读。医生应考虑患者BMI对膝关节体格检查准确性的影响，以优化治疗决策。
