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.
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.
Authors: S Décary; M Fallaha; B Pelletier; P Frémont; J Martel-Pelletier; J-P Pelletier; D E Feldman; M-P Sylvestre; P-A Vendittoli; F Desmeules Journal: BMC Musculoskelet Disord Date: 2017-11-14 Impact factor: 2.362
Authors: Harry P A Wagemakers; Pim A J Luijsterburg; Edith M Heintjes; Marjolein Y Berger; Jan Verhaar; Bart W Koes; Sita M A Bierma-Zeinstra Journal: Br J Gen Pract Date: 2010-02 Impact factor: 5.386
Authors: Kim van Oudenaarde; Nynke M Swart; Johan L Bloem; Sita Ma Bierma-Zeinstra; Paul R Algra; Bart Koes; Jan Verhaar; Rob Ghh Nelissen; Patrick Je Bindels; Pim Aj Luijsterburg; Monique Reijnierse Journal: Br J Gen Pract Date: 2017-12 Impact factor: 5.386
Authors: Harry P A Wagemakers; Pim A J Luijsterburg; Edith M Heintjes; Marjolein Y Berger; Jan A N Verhaar; Bart W Koes; Sita M A Bierma-Zeinstra Journal: Br J Gen Pract Date: 2012-08 Impact factor: 5.386
Authors: Edwin H G Oei; Ingrid M Koster; Jan-Hein J Hensen; Simone S Boks; Harry P A Wagemakers; Bart W Koes; Dammis Vroegindeweij; Sita M A Bierma-Zeinstra; M G Myriam Hunink Journal: Eur Radiol Date: 2009-11-17 Impact factor: 5.315