Assessing Medial Collateral Ligament Knee Lesions in General Practice

PURPOSE: To assess the diagnostic value of history-taking and physical examination of medial collateral ligament lesions after a knee injury presenting in general practice. METHODS: Patients aged 18 to 65 years with a traumatic knee injury who consulted their general practitioner within 5 weeks after trauma filled out a questionnaire, underwent a standardized physical examination, and underwent a magnetic resonance imaging scan. Logistic regression analysis was used to test possible associations between determinants from history-taking/physical examination and medial collateral ligament lesions. The diagnostic value of history-taking and physical examination was determined for those variables indicating an association (P <. 15) with medial collateral ligament lesions and was assessed by sensitivity, specificity, predictive value, and likelihood ratios. RESULTS: Of the 134 patients included in this study, 35 had a medial collateral ligament lesion seen on magnetic resonance imaging scan. From history-taking, the determinants "trauma by external force to leg" and "rotational trauma" showed an association with medial collateral ligament lesion after multivariate analysis (P <. 15). From physical examination," pain valgus stress 30 degrees" and "laxity valgus stress 30 degrees" showed an association (P <. 15). Isolated determinants from history-taking and physical examination showed some diagnostic value; the likelihood ratio positive was 2.0 for " trauma by external force to leg" and 2.3 for "pain valgus stress 30 degrees" Adding "pain valgus stress 30 degrees" and "laxity valgus stress 30 degrees" from physical examination to history-taking improved the diagnostic value to a likelihood ratio positive of 6.4. CONCLUSION: Medial collateral ligament lesions are frequently seen in patients with traumatic knee injury. History-taking has a diagnostic value, while adding physical examination increases the diagnostic value. (C) 2008 Elsevier Inc. All rights reserved.