ارزيابي معاينه هاي باليني براي تشخيص آسيب هاي منيسك وليگامان متقاطع قدامي

Evaluation of Clinical Examination in Diagnosis of Knee Anterior Cruciate Ligament and Meniscal Injuries

Background: Knee meniscal and anterior cruciate ligament (ACL) injuries arc common. Arthroscopic surgery for meniscal pathology is one of the most common arthroscopic operations done for knee derangement. Different clinical tests have been designed to pinpoint the status of ACL. post trauma; such as Pivot Shift and Lachman. Meniscus tear is more commonly diagnosed clinically by Mc Murray test and joint line tenderness. Use of MRI, to confirm the diagnosis has become popular in recent years. Arthroscopic evaluation is a more direct and fruitful technique for diagnosis of such infra-articular pathologies. This study is aimed at assessing the value of clinical tests in diagnosis of ACL and meniscus injuries. Materials and Methods: 177 patients, underwent diagnostic knee arthroscopy in accordance with their positive clinical findings for meniscus or ACL injury. The clinical examinations were all done by a single surgeon and included Mc Murray testing, joint line tenderness, Lachman and Pivot Shift tests. The arthroscopic findings were compared with clinical pre-operative tests. The sensitivity, specificity, positive and negative predictive values of the clinical tests were calculated. Results: The sensitivities of tests for diagnoses of medial meniscal, lateral meniscal and ACL injuries were 98%, 60% and 95% respectively, while specificities were 97%, 100% and 98%. The positive predictive values were 97%, 100% and 96%; and the negative predictive value were 98%, 84% and 97%. Conclusion: Using Mc Murray test combined with joint line tenderness in the case of meniscal injuries, and Lachman test combined with lateral Pivot Shift test in the case of ACL injuries increases the sensitivity, specificty, reliability and accuracy of diagnosis in clinical examination of knee injuries.