The diagnostic accuracy of history, physical examination, and radiographs in the evaluation of traumatic knee disorders

Abstract

We prospectively looked at the diagnostic accuracy of clinical examination of the knee in patients with arthroscopically documented knee injuries. The study included 156 patients with 156 knee injuries (72 acute and 84 chronic) who were seen during 1 year at Martin Army Hospital at Fort Benning Georgia. All patients were given a primary diagnosis based on their history, physical examination, and routine radiographs. Fifty-seven patients were also given one or more secondary diagnoses. Magnetic resonance imaging scans and arthrograms were not used in the evaluation of these patients. The primary diagnosis was correct in 83% of the knees. Of 57 secondary diagnoses given, 54% were correct and 31% were incomplete. An incorrect diagnosis was made in 14% of knees for both primary and secondary diagnoses. There were four patients with no identifiable lesion other than synovitis. With the increasing cost of medical care, the need for expensive diagnostic studies such as magnetic resonance imaging needs to be evaluated. The cost of a magnetic resonance image scan ranges between $600 to $1200 depending on the institution. The use of magnetic resonance imaging as a routine diagnostic aid in the clinical examination of the knee is unnecessary. Arthroscopic surgery of the knee should be based on the patient's history, physical examination, and radiographs.