RELIABILITY OF THE CLINICAL-ASSESSMENT IN PREDICTING THE CAUSE OF INTERNAL DERANGEMENTS OF THE KNEE

The reliability of the clinical assessment, which comprised history, p hysical examination, and plain radiographs, was determined by comparin g the initial preoperative diagnosis with the postoperative diagnosis as determined arthroscopically, and by comparing the results of the cl inical evaluation with published reports of arthrography, computed tom ography (CT), and magnetic resonance imaging (MRI). The study group in cluded 206 patients (216 knees) scheduled for arthroscopic surgery for suspected internal derangements. The primary preoperative clinical di agnosis was correct in 175 knees (81%), with an overall accuracy of 93 %, sensitivity of 89%, and specificity of 94%. The most common preoper ative diagnoses were medial and lateral meniscal tears. Results of the clinical assessment were comparable or superior to published reports of arthrography, CT, and MRI. Thus, it may be unnecessary to routinely use these costly special studies to determine the need for arthroscop ic surgery. We conclude that a thorough clinical assessment can provid e sufficient information for the surgeon to make a definitive primary preoperative diagnosis, and that arthroscopy should not be performed w ithout first completing a complete preoperative examination.