Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis. (January 2017)

• Record Type: Journal Article
• Authors: Décary, Simon; Ouellet, Philippe; Vendittoli, Pascal-André; Roy, Jean-Sébastien; Desmeules, François
• Is Part Of: Physical therapy in sport. Volume 23(2017)
• Page Start: 143
• Page End: 155
• Publication Date: 2017-01
• Subjects: SR Systematic-review -- MA Meta-analysis -- ACL Anterior cruciate ligament injuries -- PCL Posterior cruciate ligament injuries -- OA Osteoarthritis -- PFP Patellofemoral pain -- PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses -- Sn Sensitivity -- Sp Specificity -- PPV Positive predictive value -- NPV Negative predictive value -- LR Likelihood ratio -- DOR Diagnostic odds ratio -- AMSTAR Assessment of methodological quality of multiple systematic reviews; Knee -- Validity -- Physical examination tests -- Diagnostic; Sports physical therapy -- Periodicals; Sports injuries -- Patients -- Rehabilitation -- Periodicals; Athletic Injuries -- diagnosis -- Periodicals; Athletic Injuries -- therapy -- Periodicals; Physical Therapy -- Periodicals; Sports Medicine -- Periodicals; 615.82088796
• DOI: 10.1016/j.ptsp.2016.08.002
• Languages: English
• ISSNs: 1466-853X

Abstract

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. Highlights: The Lachman is able to rule in or out an ACL injury. No other individual test is able to rule in or out a knee disorder. Based on limited evidence, complete physical examination may improve validity. Clinical prediction rules are required to enhance clinicians' diagnostic capacities.