title: Diagnostic value of medical history and physical examination of anterior cruciate ligament injury: comparison between primary care physician and orthopaedic surgeon.
abstract: OBJECTIVE
  Well-designed validity studies on the clinical diagnosis of anterior cruciate ligament (ACL) injury are scarce. Our purpose is to assess the diagnostic value of ACL-specific medical history assessment and physical examination between primary and secondary care medical specialists.
  
  
  METHODS
  Medical history assessment and physical examination were performed by both an orthopaedic surgeon and a primary care physician, both blinded to all clinical information, in a secondary care population. A knee arthroscopy was used as reference standard. A total of 60 participants were divided into an index group with an arthroscopically proven complete ACL rupture and a control group with an arthroscopically proven intact ACL.
  
  
  RESULTS
  The orthopaedic surgeon recognized 94 % of the participants with an ACL rupture through a positive medical history combined with a positive physical examination; of the participants with an intact ACL, 16 % were misclassified by the orthopaedic surgeon. The primary care physician recognized 62 % of the participants with an ACL rupture and misclassified 23 % of the participants with an intact ACL. Physical examination appeared to have no additional value for the primary care physician.
  
  
  CONCLUSIONS
  Combined medical history and physical examination have strong diagnostic value in ACL rupture diagnostics performed by an orthopaedic surgeon, whereas for the primary care physician, only medical history appeared to be of value. For current practice, this could mean that only orthopaedic surgeons can perform an ACL physical examination with accuracy.
  
  
  METHODS
  III.
authors.forename: Stijn E W
authors.initials: SE
authors.lastname: Geraets
authors.forename: Duncan E
authors.initials: DE
authors.lastname: Meuffels
authors.forename: Belle L
authors.initials: BL
authors.lastname: van Meer
authors.forename: Hans P
authors.initials: HP
authors.lastname: Breedveldt Boer
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.forename: Max
authors.initials: M
authors.lastname: Reijman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010808:Physical Examination / Q000379:methods*; D058007:Physicians, Primary Care; D012189:Retrospective Studies; D066231:Surgeons; D015599:Trauma Severity Indices; D000078329:Workforce; D055815:Young Adult