The Rational Clinical Examination
David L. Simel, Drummond Rennie
Knee Ligaments and Menisci
Make the Diagnosis: Knee Ligaments and Menisci
Topics Discussed:
criterion standard comparisons (diagnostic tests), knee ligament, knee ligament injury, knee meniscus, knee meniscus tears, knee pain, likelihood ratio, make the diagnosis, prior probability
Excerpt:
"The physical examination can help in determining which patients
are likely to have meniscal or ligamentous injuries of the knee. However,
no data exist that allow us to establish reliable prior probability
estimates. Among patients with knee pain referred by primary care
providers or rheumatologists to an orthopedist, the orthopedist
will clinically diagnose meniscal tears in about 25% of patients
and ligamentous injuries in about 10%.2 We
do not know the underlying distribution of these conditions in patients
who do not require referral. Because the mechanism of an injury
predicts the actual anatomic defect, experts probably can predict
(better than chance) the most likely injury when they either observe
the trauma or get a reliable medical history...."
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