300 Section - Can history questions inform acute sport-related knee injury diagnosis? A systematic review.

Accurate early diagnosis of acute sport-related knee injuries often depends on physical examination and imaging, which may be unavailable in remote or early-triage settings. History questions are routinely used to guide initial clinical decisions, yet the diagnostic accuracy of history features remains unclear. The objective of this systematic review was to evaluate the diagnostic accuracy of patient-reported history questions in identifying common acute knee injury diagnoses. 

Design: A systematic review was conducted adhering to 2020 PRISMA guidelines. Six databases were searched. Eligible studies included original diagnostic accuracy research, cohort studies, and case series with ≥10 participants evaluating history questions for acute (< 6 weeks) knee injury diagnosis in adolescents or adults. Two reviewers independently screened studies, extracted data, and appraised risk of bias using the SIGN tool. Reference standards included arthroscopy, MRI, ultrasound, radiographs, or expert clinical examination.

Results: From 1,643 screened records, 13 studies met inclusion criteria. Four studies were rated low risk of bias (high-quality), six acceptable risk of bias, and three studies with a high risk of bias (low-quality). Thirty-seven unique diagnoses were represented; ACL and meniscal injuries were most commonly studied. History features including: functional impairment, effusion, instability, and an audible “pop” demonstrated moderate diagnostic accuracy for ACL injury, with sensitivities up to 0.94 and specificities up to 0.66. Evidence for meniscal injury was inconsistent, and limited or low-quality evidence existed for collateral ligament, chondral, and patellofemoral instability injuries.

Conclusion: History questions relating to functional impairment, effusion, instability, and a “pop” sensation informed diagnosis of ACL injury with up to 0.94 sensitivity and 0.66 specificity. History questions regarding type of sport or classification of contact versus non-contact mechanism of injury demonstrated conflicting evidence in informing meniscal injury. High quality studies evaluating history questions to inform diagnosis of collateral ligament, chondral, and patellofemoral instability injuries are needed.