Article

OBJECTIVE: To assess the diagnostic value of history taking and physical
examination for knee joint effusion in patients with a knee injury who consult
their general practitioner (GP).
In addition, to determine the association
between effusion seen on magnetic resonance imaging (MRI) and internal
derangement of the knee. DESIGN: Prospective, observational cohort study.
SETTING: Primary care. PARTICIPANTS: Patients (N=134) aged 18 to 65 years with a
traumatic knee injury who consulted their GP. MAIN OUTCOME MEASURES: Patients filled out a questionnaire, underwent a standardized
physical examination and underwent an MRI scan to assess the presence of
effusion. Multivariate logistic regression analysis was used to determine the
diagnostic value of history taking and physical examination (P<0.10) as assessed
by sensitivity, specificity, predictive values, and likelihood ratios. The
relationship between effusion and internal derangement of the knee was assessed
with a chi-square test. RESULTS: Of the 134 participating patients, 42 had knee
joint effusion seen on MRI. Multivariate analysis showed an association with knee
joint effusion for the symptom "self-noticed swelling" (history taking) and for
the "ballottement test" (physical examination). The likelihood ratio positive
(LR+) was 1.5 for self-noticed swelling and 1.6 for the ballottement test. These
2 combined improved the diagnostic value to an LR+ of 3.6. Effusion showed a
positive association with internal derangement of the knee (chi-square 9.5); 31
of the 42 patients with knee joint effusion had internal derangement of the knee.
CONCLUSIONS: In patients with traumatic knee injury, knee joint effusion is
frequently seen on MRI.
The combination of self-noticed swelling and the
ballottement test was of diagnostic value. Knee joint effusion was associated
with internal derangement of the knee.

Langue : ANGLAIS

Tiré à part : OUI