Diagnostic knee arthroscopy: findings and their correlation with clinical impressions at mulago hospital.

Abstract

INTRODUCTION: A number of patients present to the orthopaedic surgeon with complaints of knee pain. A diagnosis based on clinical examination only is frequently inaccurate and arthroscopy is considered to be the gold standard in diagnosis of knee conditions. In the pilot study, it was noted that about 2% of patients in the mulago hospital orthopaedic clinic had knee conditions without a definite diagnosis. There are no studies in Uganda documenting the commonly encountered pathologies of the knee to guide clinicians in making these diagnoses. This study thought to document the common findings at arthroscopy and compare them with clinical impressions, with an aim of establishing their correlation in mulago hospital. METHODS: This was a cross sectional study involving 34 patients who underwent a diagnostic knee arthroscopy procedure at the orthopaedic theatre of mulago hospital for an undetermined knee diagnosis. Consecutive sampling was used and both the preoperative clinical impressions and the findings at arthroscopy were documented and analysed. RESULTS: The commonest preoperative clinical impression was a medial meniscal tear (21%). At arthroscopy, by far, the commonest finding was an osteochondral lesion (27%). The most correct correlation between the clinical impressions and arthroscopic findings was in ACL tears and osteoarthritis, while the greatest discrepancy was in osteochondral lesions. The overall accuracy of clinical examination was 87.2%. CONCLUSION: Clinical examination is a useful tool in diagnosing knee pathologies. In mulago, the accuracy of the referring physicians is high. There is however need to strengthen training of medical personnel in diagnosis of knee derangements so as to reduce the missed diagnoses.