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The accuracy of the clinical knee examination documented by arthroscopy

A prospective study

Hughston Orthopaedic Clinic, PC, Columbus, Georgia, Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana

Robert M. Shalvoy, MD

Hughston Orthopaedic Clinic, PC, Columbus, Georgia, Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana

Jack C. Hughston, MD

Hughston Orthopaedic Clinic, PC, Columbus, Georgia, Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana

The diagnostic accuracy of the clinical examination for intraarticular injuries of the knee was documented by arthroscopy over a 6-month period. Two-hundred ninety patients (296 knees) were evaluated by history, physical examination, and standard radiographs. Supplemental diagnostic studies included 41 magnetic resonance images, 2 arthrograms, and 1 previous ar throscopy that had been recently performed.

Overall, the correct diagnosis was made in 165 knees (56%), an incomplete diagnosis in 92 (31%), and an incorrect diagnosis in 39 (13%). There were only 2 knees (0.07%) with no discernable lesions. When a single lesion was present in the knee, the diagnosis was made correctly in 72% of cases. When more than 2 were discovered, the diagnosis was correct in only 30%. However, all individual lesions were diagnosed with an accuracy of greater than 90%.

The lesions most difficult to diagnose were chondral fractures, fibrotic fat pads, tears in the anterior cruciate ligament, and loose bodies. Knees with acute lesions and those with a single diagnosis proved to be signifi cantly easier to diagnose (P < 0.01). The variables that proved to be insignificant were age, sex, magnetic resonance imaging, surgeon, workers' compensation, or pending litigation.

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