Assessing medial collateral ligament knee lesions in general practice.

PURPOSE: To assess the diagnostic value of history-taking and physical examination of medial collateral ligament lesions after a knee injury presenting in general practice.
METHODS: Patients aged 18 to 65 years with a traumatic knee injury who consulted their general practitioner within 5 weeks after trauma filled out a questionnaire, underwent a standardized physical examination, and underwent a magnetic resonance imaging scan. Logistic regression analysis was used to test possible associations between determinants from history-taking/physical examination and medial collateral ligament lesions. The diagnostic value of history-taking and physical examination was determined for those variables indicating an association (P <.15) with medial collateral ligament lesions and was assessed by sensitivity, specificity, predictive value, and likelihood ratios.
RESULTS: Of the 134 patients included in this study, 35 had a medial collateral ligament lesion seen on magnetic resonance imaging scan. From history-taking, the determinants "trauma by external force to leg" and "rotational trauma" showed an association with medial collateral ligament lesion after multivariate analysis (P <.15). From physical examination, "pain valgus stress 30 degrees " and "laxity valgus stress 30 degrees " showed an association (P <.15). Isolated determinants from history-taking and physical examination showed some diagnostic value; the likelihood ratio positive was 2.0 for "trauma by external force to leg" and 2.3 for "pain valgus stress 30 degrees ." Adding "pain valgus stress 30 degrees " and "laxity valgus stress 30 degrees " from physical examination to history-taking improved the diagnostic value to a likelihood ratio positive of 6.4.
CONCLUSION: Medial collateral ligament lesions are frequently seen in patients with traumatic knee injury. History-taking has a diagnostic value, while adding physical examination increases the diagnostic value.