Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis.
BACKGROUND
More evidence on diagnostic validity of physical examination tests for knee disorders is needed to lower frequently used and costly imaging tests.


OBJECTIVE
To conduct a systematic review of systematic reviews (SR) and meta-analyses (MA) evaluating the diagnostic validity of physical examination tests for knee disorders.


METHODS
A structured literature search was conducted in five databases until January 2016. Methodological quality was assessed using the AMSTAR.


RESULTS
Seventeen reviews were included with mean AMSTAR score of 5.5 ± 2.3. Based on six SR, only the Lachman test for ACL injuries is diagnostically valid when individually performed (Likelihood ratio (LR+):10.2, LR-:0.2). Based on two SR, the Ottawa Knee Rule is a valid screening tool for knee fractures (LR-:0.05). Based on one SR, the EULAR criteria had a post-test probability of 99% for the diagnosis of knee osteoarthritis. Based on two SR, a complete physical examination performed by a trained health provider was found to be diagnostically valid for ACL, PCL and meniscal injuries as well as for cartilage lesions.


CONCLUSIONS
When individually performed, common physical tests are rarely able to rule in or rule out a specific knee disorder, except the Lachman for ACL injuries. There is low-quality evidence concerning the validity of combining history elements and physical tests.
School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada. Electronic address: simon.decary.1@umontreal.ca.
Simon
S
Décary
School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada. Electronic address: philippe.ouellet.3@umontreal.ca.
Philippe
P
Ouellet
Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada; Department of Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada. Electronic address: pa_vendittoli@hotmail.com.
Pascal-André
PA
Vendittoli
Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Centers for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada. Electronic address: jean-sebastien.roy@fmed.ulaval.ca.
Jean-Sébastien
JS
Roy
School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada. Electronic address: f.desmeules@umontreal.ca.
François
F
Desmeules
D001265:Athletic Injuries / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis*; D010808:Physical Examination / Q000379:methods*
Diagnostic; Knee; Physical examination tests; Validity