title: A clinical composite score accurately detects meniscal pathology.
abstract: OBJECTIVE
  Five common tests were used to diagnose meniscal tears when used as a composite score. We evaluated how effectively the composite examination, when performed in the presence of an anterior cruciate ligament (ACL) injury or degenerative joint disease (DJD), determined the presence of meniscal tears.
  
  
  METHODS
  Data were collected prospectively on all patients at our clinic with a primary knee complaint. Independent variables included the presence or absence of the following: (1) a history of "catching" or "locking" as reported by the patient, (2) pain with forced hyperextension, (3) pain with maximum flexion, (4) pain or an audible click with McMurray's maneuver, and (5) joint line tenderness to palpation. Comprehensive patient demographic data were collected including ligamentous examinations and other intra-articular pathologies found at arthroscopy. Composite examination findings were correlated with the presence or absence of meniscal pathology.
  
  
  RESULTS
  We evaluated 635 knees in 576 patients for historical and physical findings. Of the knees, 209 underwent arthroscopic surgery and 426 did not. Chi(2) Analysis showed a significant relation between the number of positive diagnostic tests and the presence of meniscal tears (P = .001). Five positive findings on composite examination yielded a positive predictive value of 92.3%. Positive predictive values remained greater than 75% with composite scores of at least 3 in the absence of ACL and DJD pathologies. The presence of an ACL injury decreased the positive predictive value of 5 composite findings to 67%, whereas the presence of DJD increased predictability to 100%.
  
  
  CONCLUSIONS
  When all 5 symptoms and signs were positive, there was a 92.3% positive predictive value of finding a meniscal tear. Although positive predictive values decreased with a concomitant ACL injury and increased with DJD, there was a higher rate of false-positive findings (ACL) and false-negative findings (DJD).
  
  
  METHODS
  Level II, development of diagnostic criteria with consecutive patients and gold standard.
authors.affiliation: Orthopaedic Associates, Evansville, Indiana, USA.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Lowery
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Farley
authors.forename: David W
authors.initials: DW
authors.lastname: Wing
authors.forename: William I
authors.initials: WI
authors.lastname: Sterett
authors.forename: J Richard
authors.initials: JR
authors.lastname: Steadman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070598:Anterior Cruciate Ligament Injuries; D002648:Child; D003955:Diagnostic Tests, Routine / Q000592:standards; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000150:complications*; D007719:Knee Joint; D022125:Lacerations / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000070600:Tibial Meniscus Injuries