title: Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care.
abstract: OBJECTIVE
  To assess the diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament (ACL) lesions in primary care.
  
  
  METHODS
  Cross-sectional diagnostic study.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  Patients (N=134; age, 18-65y) who consulted their general practitioner (GP) within 5 weeks after injury.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Index tests were obtained with a questionnaire and physical examination. Magnetic resonance imaging (MRI) was used as the reference test. Logistic regression analysis was used to determine associations with ACL lesions. Diagnostic accuracy was determined by calculating sensitivity (Se), specificity (Sp), predictive values, and likelihood ratio (LR).
  
  
  RESULTS
  MRI showed an ACL lesion in 28 of 134 included patients. "Effusion," "popping sensation," "giving way," and "anterior drawer test (ADT)" showed associations with an ACL lesion (P<.05). Popping sensation showed Se, Sp, positive predictive value (PPV), and positive LR (LR(+)) of .63, .73, .39, and 2.3, respectively. Combining determinants from history taking (2 of 3 positive results regarding effusion, popping sensation, and giving way) improved diagnostic accuracy (Se, .71; Sp, .71; PPV, .42; and LR(+), 2.5). The ADT added diagnostic accuracy to these combinations (Se, .63; Sp, .85; PPV, .52; and LR(+), 4.2).
  
  
  CONCLUSIONS
  ACL lesions are seen frequently. Based on history taking (effusion, popping sensation, and/or giving way) and physical examination (ADT), GPs can screen for ACL lesions in primary care.
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Harry P
authors.initials: HP
authors.lastname: Wagemakers
authors.forename: Pim A
authors.initials: PA
authors.lastname: Luijsterburg
authors.forename: Simone S
authors.initials: SS
authors.lastname: Boks
authors.forename: Edith M
authors.initials: EM
authors.lastname: Heintjes
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
authors.forename: Jan A
authors.initials: JA
authors.lastname: Verhaar
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; D000070598:Anterior Cruciate Ligament Injuries; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000534:rehabilitation; D008279:Magnetic Resonance Imaging; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010808:Physical Examination; D011237:Predictive Value of Tests; D015203:Reproducibility of Results