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January 2, 2002

Physical Examination of Knee Injuries—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2002;287(1):40-41. doi:10.1001/jama.287.1.40

In Reply: Unfortunately, most studies of the physical findings in knee injuries have been performed in orthopedic surgery practices where the prevalence and severity of ligamentous and meniscal pathology are higher than in primary care settings. Orthopedic surgeons generally also have more experience than primary care physicians in examining knees, suggesting that the sensitivity and specificity reported in the studies we reviewed are at the upper limits of what can be expected by nonspecialists. Another problem raised by conducting these studies in typical surgical practice, as pointed out by Dr Bernstein, is that patients with negative examination results (including false negatives) are not sent for the criterion standard test, surgery. This would result in overestimation of a test's sensitivity. Furthermore, as Ms Heintjes and colleagues suggest, patient selection criteria were not carefully detailed in most articles we included. Thus, our review is limited by weaknesses in the underlying literature.

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