title: Diagnostic value of history taking and physical examination to assess effusion of the knee in traumatic knee patients in general practice.
abstract: OBJECTIVE
  To assess the diagnostic value of history taking and physical examination for knee joint effusion in patients with a knee injury who consult their general practitioner (GP). In addition, to determine the association between effusion seen on magnetic resonance imaging (MRI) and internal derangement of the knee.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  Patients (N=134) aged 18 to 65 years with a traumatic knee injury who consulted their GP.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Patients filled out a questionnaire, underwent a standardized physical examination and underwent an MRI scan to assess the presence of effusion. Multivariate logistic regression analysis was used to determine the diagnostic value of history taking and physical examination (P<0.10) as assessed by sensitivity, specificity, predictive values, and likelihood ratios. The relationship between effusion and internal derangement of the knee was assessed with a chi-square test.
  
  
  RESULTS
  Of the 134 participating patients, 42 had knee joint effusion seen on MRI. Multivariate analysis showed an association with knee joint effusion for the symptom "self-noticed swelling" (history taking) and for the "ballottement test" (physical examination). The likelihood ratio positive (LR+) was 1.5 for self-noticed swelling and 1.6 for the ballottement test. These 2 combined improved the diagnostic value to an LR+ of 3.6. Effusion showed a positive association with internal derangement of the knee (chi-square 9.5); 31 of the 42 patients with knee joint effusion had internal derangement of the knee.
  
  
  CONCLUSIONS
  In patients with traumatic knee injury, knee joint effusion is frequently seen on MRI. The combination of self-noticed swelling and the ballottement test was of diagnostic value. Knee joint effusion was associated with internal derangement of the knee.
authors.affiliation: Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands. m.kastelein@erasmusmc.nl
authors.forename: Marlous
authors.initials: M
authors.lastname: Kastelein
authors.forename: Pim A
authors.initials: PA
authors.lastname: Luijsterburg
authors.forename: Harry P
authors.initials: HP
authors.lastname: Wagemakers
authors.forename: Santusha C
authors.initials: SC
authors.lastname: Bansraj
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Sita M
authors.initials: SM
authors.lastname: Bierma-Zeinstra
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies