Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis.

INTRODUCTION: More evidence on diagnostic validity of physical examination tests for knee disorders is needed to lower frequently used and costly imaging tests.

OBJECTIVE: To conduct a systematic review of systematic reviews (SR) and meta-analyses (MA) evaluating the diagnostic validity of physical examination tests for knee disorders.

METHODS: A structured literature search was conducted in five databases until January 2016. Methodological quality was assessed using the AMSTAR.

RESULTS: Seventeen reviews were included with mean AMSTAR score of 5.5 ± 2.3. Based on six SR, only the Lachman test for ACL injuries is diagnostically valid when individually performed (Likelihood ratio (LR+):10.2, LR-:0.2). Based on two SR, the Ottawa Knee Rule is a valid screening tool for knee fractures (LR-:0.05). Based on one SR, the EULAR criteria had a post-test probability of 99% for the diagnosis of knee osteoarthritis. Based on two SR, a complete physical examination performed by a trained health provider was found to be diagnostically valid for ACL, PCL and meniscal injuries as well as for cartilage lesions.

CONCLUSION: When individually performed, common physical tests are rarely able to rule in or rule out a specific knee disorder, except the Lachman for ACL injuries. There is low-quality evidence concerning the validity of combining history elements and physical tests.