Diagnostic Testing Series: Knee

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Abstract:
Knee pathologies are common complaints for athletes and active patients presenting to athletic trainers for assessment and intervention, and though often not as complex as other joints in the body (ie, shoulder or hip), can present significant diagnostic challenges when imaging techniques are not readily or immediately available. Common traumatic disorders of the knee include forces that impact the menisci, ligaments, bones, and associated joints (ie, patellofemoral, tibiofemoral), while overuse injuries involving the patellofemoral joint, surrounding tissues (ie, IT Band), patellar tendon and tibiofemoral joint can challenge the unsuspecting diagnostician, as well. Undiagnosed, or improperly diagnosed knee conditions can also lead to lifelong disability and/or profound decreases in health-related quality of life and functional enjoyment. Unsuspecting or inexperienced clinicians in all branches of sports medicine, if not careful can naively rely on special test results in isolation, or upon medical imaging for a working or final diagnosis, which includes false positive and negative results, increases overall healthcare costs, and/or cause unnecessary delays in treatment or return to participation. Experts in medical research have confirmed that accurate diagnoses come from the history portion of the exam in over 80 to 90% of cases and that individual physical exam test results should be viewed with suspicion in isolation. The focus of this presentation is to present the athletic training profession a review of physical examination special tests for common knee injuries and conditions, while also introducing or reviewing the evidence behind each test's respective diagnostic accuracy. In so doing, an overview of diagnostic accuracy terms and principles will be presented, followed by available diagnostic accuracy dates for each test presented in order for clinicians to become more aware of the strengths and limitations of tests commonly used to help assess athletic injuries of the knee.

Objectives:

  • Participants will be able to state the fundamental principles and terms associated with diagnostic accuracy of physical examination tests, including sensitivity and specificity, positive and negative likelihood ratios, positive and negative predictive values, and overall utility scores., 
  • Participants will be able to identify the most useful, evidence-based physical examination tests for assessing various conditions of the knee., 
  • Participants will be able to recognize and incorporate the best-evidence tests in times of acute and chronic assessment of common knee injuries., 
  • Participants will be able to apply use of pooled tests in order to more accurately assess various orthopedic conditions of the knee in athletes and active patients.

Level:
Advanced

Domains:
Domain 2: Assessment Evaluation and Diagnosis

CEUs:
1.25 Category A

Keywords: knee, orthopedic, menisci, ligaments, bones, joints, patellofemoral, tibiofemoral

Paul Geisler, EdD, AT Ret.

Associate Dean Geisler is a native of Lakeville, MA and current resident of Boston, MA. A certified athletic trainer since 1987 with over 15 years of varied clinical practice and 23 years' experience directing athletic training education programs at Georgia Southern University and Ithaca College. He is deeply interested in the development and assessment of the medico-clinical thinking processes of novice and experienced clinicians, the development of adaptive expertise in clinicians, progressive curriculum design, capability-based education, and meaningful programmatic assessment. He has over 170 national and international presentations and publications on clinical and educational based subjects in athletic training and health professions education to his credit. He is a member of the European Board of Medical Assessors, and past member of the Association of Medical Education, Europe.

As a scholar, he is the recipient of two manuscript awards from the Journal of Athletic Training and the Athletic Training Education Journal. For his many professional contributions, he has been the recipient of the NATA Athletic Training Service Award and NATA Most Distinguished Athletic Trainer Award. As an educator, he was awarded the NATA Executive Council on Education's Sayers "Bud" Miller Distinguished Educator Award in 2021 and has received two Dean's Awards for Excellence & Innovation in Teaching, a Dean's Excellence Award for Diversity and Inclusion in Teaching and Learning, and the all college Faculty Excellence Award, all from Ithaca College.

He admits to being an enthusiastic but slow road cyclist, an amateur shutterbug of nature and wonder, an aspiring wine snob and amateur foodie, and an unabashed promoter of equal rights, freedom, justice, and authentic democracy for all living beings. Susan, his life partner and wife of 34 years and he are fulfilled parents of two amazing young men – Nicholas, a writer living in Los Angeles, CA and Benjamin, a photographer and artist living in Brooklyn, NY.



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