The development of an evidence-based clinical checklist for the diagnosis of anterior knee pain.
Dominique C Leibbrandt, Quinette Louw
PMID 30135903WHAT IT FOUND
A checklist for anterior knee pain combines pain with squatting, kneeling, stairs or sitting and tests to exclude other knee problems.
Squatting reproduced pain in 91% of patients, but the paper did not report testing the checklist.
Key findings
01Squatting had the highest sensitivity of the functional tests at 91%, followed by kneeling at 84%, stair ascent or descent at 75% and prolonged sitting at 72%.
02Among manual tests, only the patella compression test (83% sensitivity) and the patella tilt test (likelihood ratio 5.4) were recommended as diagnostic tests for anterior knee pain.
03The checklist includes anterior drawer, posterior drawer, valgus stress, varus stress, McMurray's and patellar ballottement tests to exclude intra-articular pathology.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The paper developed a checklist but did not test whether the checklist improves diagnosis, patient management or outcomes. Only two systematic reviews were included, and four of the nine diagnostic studies within them were excluded because they used arthroscopic surgery. The search was limited to English-only studies and to systematic reviews, so relevant primary diagnostic studies may not have been considered. Anterior knee pain is described as a diagnosis of exclusion and may include different pathologies, so the checklist may not apply to all knee pain presentations. The accuracy table reports squatting sensitivity 91% and specificity 50%, and patella tilt test sensitivity 43% and specificity 92%.
The easy way to misread this
Do not assume the checklist has been validated or that a positive squatting test confirms anterior knee pain. The paper compiled tests from systematic reviews and did not report testing the finished checklist.