How valid are physical examination tests for knee disorders?
Knee disorders, including meniscal and ACL injuries, and degenerative disorders are highly prevalent. The initial diagnosis is crucial to enable an efficient management. The key factors for an optimal management seem to remain the patient history elements, in combination with physical examination tests. However, the evidence on these key factors remains unclear and thus this systematic review aims to provide an update on information for clinicians working with individuals with knee disorders.
A literature research on systematic reviews and meta-analyses was carried out. The quality of the studies was assessed by using the assessment of methodological quality of the included systematic reviews (AMSTAR tool). The diagnostic properties of the clinical 109 tests under were extracted and investigated.
The results showed that:
- Tests to assess meniscal injuries have been shown to have a poor diagnostic validity when individually used and thus the combination of tests is advised, although no evidence could support this approach.
- The anterior drawer test may be used to rule in an ACL injury, and could ruled out with the Lachman
- Clinical prediction rules for fractures cannot rule out a fracture and thus radiograph is needed
- The diagnosis of knee OA can be done with the clinical criteria, but grading of OA can only been assessed by radiography
- No individual tests can be recommended at this time to diagnose or exclude patellofemoral pain and posterior cruciate ligament injuries
- Physical examination may be diagnostically superior to individual tests but needs further research.
To sum up, reviews provide high-quality evidence that clinicians may diagnose or exclude an ACL injury with the Lachman test, exclude a knee fracture using the Ottawa Knee Rule and make a diagnosis of knee OA based on the results of the American College of Rheumatology and EULAR rules. For other knee disorders (meniscal injury, PFP, PCL injury) the evidence suggests that the tests are not clinically valid.
> From: Décary et al., Phys Ther Sport (2016) (Epub ahead of print). All rights reserved to The Author(s). Click here for the Pubmed summary.