Knee pain dilemma and the initial step to predicting diagnoses in general practice: a cross-sectional study
Valerie H. J. Debie
1 # * , Ann-Sophie Puls 1 # , Luc J. M. Heijnens 2 , Jochen W. L. Cals 1 , Ralph T. H. Leijenaar 1 ‡ , Ramon P. G. Ottenheijm 1 ‡
1
2
Abstract
Knee pain is a common reason to consult a general practitioner (GP), but accurate diagnosis poses a challenge for GPs. To support GPs with this diagnostic dilemma in patients with knee pain, a prediction model could be a useful diagnostic decision support tool.
This study explores the most common diagnoses in patients with knee pain referred by their GP to a primary care orthopaedic clinic, and if this diagnosis can be predicted by patients’ age.
This was a cross-sectional study of medical records of patients with knee pain in the Netherlands, referred by their GP to a primary care orthopaedic clinic between January 2021 and June 2023.
We included 627 patients with a mean age of 53.0 years (s.d. 16.9). Sixty-nine percent of the patients were diagnosed with osteoarthritis of the knee, 9% were diagnosed with patellofemoral pain, followed by a meniscal lesion in 5%. The optimal age threshold is ≥49.5 years for knee osteoarthritis (area under the receiver operator curve (AUC: 0.90, 95% CI: 0.87–0.93), <47.5 years for patellofemoral pain (AUC: 0.87, 95% CI: 0.83–0.91), and <52.5 years for meniscal lesions (AUC: 0.72, 95% CI: 0.64–0.81).
In a primary care population presenting with knee pain, in which GPs experience diagnostic challenges, an age threshold of roughly 50 years is a strong predictor for knee osteoarthritis, patellofemoral pain, and meniscal lesions, the three most common diagnoses. This study marks an initial step in simplifying the diagnostic process for knee pain, aiming to illuminate the path to a more predictive diagnostic approach.
Keywords: diagnosis, general practice, knee pain, meniscal lesion, osteoarthritis, patellofemoral pain, prediction.
References
1 Evers BJ, Schers HJ, van den Ende CHM, et al. Diagnosing knee osteoarthritis in patients, differences between general practitioners and orthopedic surgeons: a retrospective cohort study. BMC Prim Care 2023; 24(1): 155.
| Crossref | Google Scholar | PubMed |
2 Guldhammer C, Holden S, Audreucci A, et al. Development of a tool to support general practitioners to help adolescents with knee pain: an analysis using the Theoretical Domains Framework. Prim Health Care Res Dev 2023; 24: e24.
| Crossref | Google Scholar | PubMed |
3 Frese T, Peyton L, Mahlmeister J, et al. Knee pain as the reason for encounter in general practice. ISRN Family Med 2013; 2013: 930825.
| Crossref | Google Scholar | PubMed |
4 Netherlands Institute for Health Services Research (NIVEL). Zorg door de huisarts: jaarcijfers 2022 en trendcijfers 2018-2022 (in English: Care by the general practitioner: annual figures 2022 and trend data 2018-2022). 2023. Available at https://www.nivel.nl/sites/default/files/bestanden/1004432.pdf accessed 24-09-2024
5 Duong V, Oo WM, Ding C, et al. Evaluation and treatment of knee pain: a review. Jama 2023; 330(16): 1568-80.
| Crossref | Google Scholar | PubMed |
6 Peat G, Thomas E, Handy J, et al. The Knee Clinical Assessment Study--CAS(K). A prospective study of knee pain and knee osteoarthritis in the general population. BMC Musculoskelet Disord 2004; 5: 4.
| Crossref | Google Scholar | PubMed |
7 Bruyn GA, Naredo E, Damjanov N, et al. An OMERACT reliability exercise of inflammatory and structural abnormalities in patients with knee osteoarthritis using ultrasound assessment. Ann Rheum Dis 2016; 75(5): 842-6.
| Crossref | Google Scholar | PubMed |
8 Nevalainen MT, Uusimaa AP, Saarakkala S. The ultrasound assessment of osteoarthritis: the current status. Skeletal Radiol 2023; 52(11): 2271-82.
| Crossref | Google Scholar | PubMed |
9 Carter JV, Pan J, Rai SN, et al. ROC-ing along: evaluation and interpretation of receiver operating characteristic curves. Surgery 2016; 159(6): 1638-45.
| Crossref | Google Scholar | PubMed |
10 Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986; 29(8): 1039-49.
| Crossref | Google Scholar | PubMed |
