De waarde van anamnese en lichamelijk onderzoek bij het diagnosticeren van traumatisch knieletsel

Aim: To determine the value of anamnesis and physical examination in the diagnosis of patients with knee injury, particularly intra-articular knee injury. Method: We included patients aged between 18 and 65 years who visited their GP's surgery with knee trauma. Using logistic regression analysis we determined associations (p < 0.15) between anamnesis/physical examination and intra-articular knee injury and any other type of knee injury, whereby we used a supplementary MRI scan as a reference standard. If we found an association, we calculated sensitivity, specificity and prognostic value. Results: Of the 134 participating patients, 82 had some form of knee injury which, in 64 cases, was intra-articular. The items 'age > 40 years', 'rotation trauma', continuing activity impossible', 'genu flexum' and 'pain on palpation of medial collateral ligament system' showed an association in a multivariate analysis with any knee injury. The items age > 40 years', 'trauma during sport', 'rotation trauma', 'continuing activity impossible' and 'laxity of the anterior drawer test' were associated with intra-articular knee injury. In isolation, the items listed had some diagnostic value. Combining the items caused a rise in the diagnostic value but this proved insufficient for clinical use. Conclusion: Some items from anamnesis and physical examination are independently associated with intra-articular and any other form of knee injury. However it seems no longer useful to categorise knee injuries into intra-articular and extra-articular on the basis of anamnesis and/or physical examination.