O exame físico no diagnóstico de lesões meniscais: uma correlação com os achados cirúrgicos / Physical examinations for diagnosing meniscal injuries: correlation with surgical findings

RESUMO

OBJETIVO: Foi avaliado o conjunto de cinco manobras para as lesões meniscais (McMurray, Apley, Childress, Steinmann 1 e 2) e calculados a sensibilidade, especificidade, acurácia e likelyhoods do conjunto dessas manobras. Os mesmos cálculos foram aplicados a cada teste individualmente. MÉTODOS: Cento e cinquenta e dois pacientes de ambos os sexos que iriam realizar videoartroscopia do joelho foram examinados por um dos cinco residentes desse hospital de forma cega sem que esse soubesse seus dados clínicos e porque seriam operados. Esse exame era realizado imediatamente antes da videoartroscopia e seus resultados anotados em planilha eletrônica. O conjunto de manobras foi considerado positivo quando uma era positiva. Já na análise individual, bastava o teste ser positivo. RESULTADOS: A análise mostrou que o conjunto dos cinco testes meniscais apresenta 89 por cento de sensibilidade, 42 por cento de especificidade, 75 por cento de acurácia, likelyhood + de 1,53 e um likelyhood - de 0,26. Individualmente os testes apresentaram acurácia entre 48 e 53 por cento. CONCLUSÃO: O conjunto de manobras para as lesões meniscais tem boa acurácia e valor significativo, principalmente para excluir lesões. Os testes isolados têm menor valor diagnóstico, sendo o teste de Apley o de melhor especificidade.

ABSTRACT

OBJECTIVE: A set of five maneuvers for meniscal injuries (McMurray, Apley, Childress and Steinmann 1 and 2) was evaluated and their sensitivity, specificity, accuracy and likelihood were calculated. The same methods were applied to each test individually. METHODS: One hundred and fifty-two patients of both sexes who were going to undergo videoarthroscopy on the knee were examined blindly by one of five residents at this hospital, without knowledge of the clinical data and why the patient was going to undergo an operation. This examination was conducted immediately before the videoarthroscopy and its results were recorded in an electronic spreadsheet. The set of maneuvers was considered positive when one was positive. In the individual analysis, it was enough for the test to be positive. RESULTS: The analysis showed that the set of five meniscal tests presented sensitivity of 89 percent, specificity of 42 percent, accuracy of 75 percent, positive likelihood of 1.53 and negative likelihood of 0.26. Individually, the tests presented accuracy of between 48 percent and 53 percent. CONCLUSION: The set of maneuvers for meniscal injuries presented a good accuracy and significant value, especially for ruling out injury. Individually, the tests had less diagnostic value, although the Apley test had better specificity.