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Report by Michael Callaghan, Stephanie Pugh, Research and Senior 2 physiotherapists
Institution: Manchester Royal Infirmary, Manchester, UK
A short cut review was carried out to establish if there is a single best test for the diagnosis of meniscal injuries. A total of 101 papers were found using the reported search, of which four represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are shown in table 3. The clinical bottom line is that there is no single, pathognomonic clinical test to diagnose a meniscal tear adequately.
In [adults with a suspected meniscal injury] is [one clinical test better than another] at [diagnosing meniscal injury]?
A 28-year-old man presents to the Accident and Emergency Department knee review clinic two weeks after a twisting injury when playing football. The history and his symptoms make you suspicious of a meniscal injury, but you are unsure of the best test to confirm this. You wonder if there is any evidence to help you choose.
MEDLINE 1966–09/07, CINAHL 1982–05/07, AMED 1985–09/07, SPORTDiscus 1830–09/07, EMBASE 1996–09/07, via the OVID interface. In addition, the Cochrane database and PEDro database were also searched (exp knee joint) AND (exp physical examination) AND (internal derangement.mp) AND (exp menisci, tibial). LIMIT to human studies AND English language.
A total of 101 papers were retrieved. There were four systematic reviews, two with meta-analyses, which included all the other relevant papers pertinent to the three-part question.
The systematic reviews concur that a composite examination (good history and several clinical tests) may provide greater diagnostic accuracy than a specific physical test. These recommendations do not seem to apply to acutely injured knees, or those with degenerative menisci. All clinical tests tended to decrease reliability with concomitant ligament injury.
Clinical bottom line
There is no single, pathognomonic clinical test to diagnose a meniscal tear adequately.
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