For knee pain, how predictive is physical examination for meniscal injury?
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No single clinical examination element, or combination of such elements, reliably detects meniscal injury. The McMurray test is best for ruling in meniscal pathology. Assuming a 9% prevalence of meniscal tears among all knee injuries (a rate reflecting national primary care data), the posttest probability that a patient with McMurray's sign has a meniscal injury ranges from <30% to 63% (strength of recommendation [SOR]: B). In contrast, the absence of any positive physical examination findings effectively rules out meniscal pathology, yielding a posttest probability of 0.8% for lateral meniscus injury, 1.0% for medial meniscus injury, and 3.8% for any meniscal injury among primary care populations (SOR: B).
Journal of Family Practice, 53(11) 2004: 918-921.