Skip to Main Content

++

Make the Diagnosis: Knee Ligaments and Menisci

++

Prior Probability for a Ligamentous or Meniscal Tear

++

The physical examination can help in determining which patients are likely to have meniscal or ligamentous injuries of the knee. However, no data exist that allow us to establish reliable prior probability estimates. Among patients with knee pain referred by primary care providers or rheumatologists to an orthopedist, the orthopedist will clinically diagnose meniscal tears in about 25% of patients and ligamentous injuries in about 10%.2 We do not know the underlying distribution of these conditions in patients who do not require referral. Because the mechanism of an injury predicts the actual anatomic defect, experts probably can predict (better than chance) the most likely injury when they either observe the trauma or get a reliable medical history.

++

Population for Whom Ligamentous or Meniscal Injuries of the Knee Should Be Considered

++

Adults with knee pain associated with an injury or with mechanical symptoms, including clicking, catching, locking, or giving way.

++

Detecting the Likelihood of a Ligamentous or Meniscal Injury of the Knee

++

The best physical examination maneuvers for ligamentous tears or meniscal injuries are shown in Table 27-6. A JAMAInteractive displays the anatomy and some of the maneuvers described in Table 27-6 (http://jama.ama-assn.org/cgi/content/full/286/13/1610/DC1; accessed June 1, 2008).

++
Table Graphic Jump Location
Table 27-6.Physical Examination Maneuvers for Ligamentous and Meniscal Injuries of the Knee
++

Reference Standard Tests

++

Serial clinical examinations performed by a specialist are a pragmatic reference standard.

++

MRI is used to rule in or rule out ligamentous tears. Arthroscopy may be required to rule out meniscal tears.

++

Original Article: Does This Patient Have a Torn Meniscus or Ligament of the Knee?

++

Clinical Scenarios

++
Case 1
++

A 20-year-old man presents to your office complaining of knee pain after playing basketball. During the game, as he came down after jumping for a rebound, another player fell on the back of his calf. He remembers hearing a pop and had pain on standing, preventing him from playing in the remainder of the game. While on the bench, he noticed that the pain improved, but his knee ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

JAMAevidence Full Site: One-Year Subscription

Connect to the full suite of JAMAevidence content and resources including interactive self-assessment, videos, and more.

$495 USD
Buy Now

Pay Per View: Timed Access to all of JAMAevidence

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.