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To the Editor: In their Rational Clinical Examination article, Dr Solomon and colleagues¹ concluded that the physical examination of the knee would obviate the need for many imaging studies. I think that their analysis also supports the alternative explanation that imaging studies, specifically magnetic resonance (MR) scans, are essential in the diagnosis of ligament and meniscal injuries of the knee.

The authors found only a paucity of studies evaluating the physical examination of knee injuries. The evidence from these studies suggests that physical examination is only moderately accurate and that the quality of this evidence is poor. Furthermore, the authors' estimates of the sensitivity of the physical examination may be overstated, as these physical examination maneuvers have been validated only in patients who are referred for surgery. This problem goes beyond the bias of evaluating the test only in a high prevalence population, because patients with potentially false negative results . . . [Full Text of this Article]