Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care.
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.
Wagemakers
Harry P
HP
Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Luijsterburg
Pim A
PA
Boks
Simone S
SS
Heintjes
Edith M
EM
Berger
Marjolein Y
MY
Verhaar
Jan A
JA
Koes
Bart W
BW
Bierma-Zeinstra
Sita M
SM
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