The Art of the Knee Examination: Where Has It Gone?

Abstract

In the past ten years, I have become increasingly concerned as to where the practice of orthopaedics is headed. While at the Annual Meeting of the American Academy of Orthopaedic Surgeons in 2009, I had a long discussion with several of my peers from around the country about many of the problems we, as orthopaedic surgeons, are facing. The discussion included our thoughts regarding the use of technology in our profession. Although we all agreed that technology has benefited us in some ways, we also agreed that it has not necessarily made us better physicians. One of my peers stated, “I think I am a worse doctor now than I was twenty years ago.” Increasing dependence on technology, although attractive, might be making us lose our ability to reason and, hence, be good physicians. In my orthopaedic practice, I specialize in the treatment of knee injuries and I see many patients who are seeking a second opinion. In recent years, some of the trends I have observed regarding how other physicians arrive at a diagnosis have been alarming to me. I have seen some patients who had undergone a magnetic resonance imaging scan before they were seen for an initial evaluation. Some patients were told they needed a total knee arthroplasty, on the basis of radiographic findings, but they had never had their knees examined physically. Other patients were told that they needed an articular cartilage repair procedure after their physician had evaluated their radiographs and magnetic resonance imaging scan but had not examined the knee or had a conversation about pain and symptoms. I have observed that some patients are surprised when they are asked to wear shorts so I can see their legs for the physical examination. Patients have been even more surprised when their knees were touched …