Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis

Simon Décary; Philippe Ouellet; Pascal-André Vendittoli; Jean-Sébastien Roy; François Desmeules

doi:10.1016/j.ptsp.2016.08.002

Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis

Phys Ther Sport. 2017 Jan:23:143-155. doi: 10.1016/j.ptsp.2016.08.002. Epub 2016 Aug 5.

Authors

Simon Décary¹, Philippe Ouellet², Pascal-André Vendittoli³, Jean-Sébastien Roy⁴, François Desmeules⁵

Affiliations

¹ 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.
² 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.
³ 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.
⁴ 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.
⁵ 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.

PMID: 27693100
DOI: 10.1016/j.ptsp.2016.08.002

Abstract

Introduction: 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.

Conclusion: 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.

Keywords: Diagnostic; Knee; Physical examination tests; Validity.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Athletic Injuries / diagnosis*
Diagnosis, Differential
Humans
Knee Injuries / diagnosis*
Physical Examination / methods*