Supplementary file 1_Diagnostic accuracy of physical examination for the assessment of popliteal cysts: a meta-analysis.docx

BackgroundPopliteal cysts are common knee cystic lesions and a potential risk factor for knee osteoarthritis, but the vast majority are asymptomatic. Early diagnosis is crucial for effective management. Physical examination is a convenient, non-invasive, and cost-free diagnostic tool, but its accuracy for popliteal cysts remains controversial. This meta-analysis evaluates the diagnostic value of physical examination for popliteal cysts.
MethodsPubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases were searched for studies on physical examination for popliteal cyst diagnosis from inception to November 30, 2025. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Heterogeneity was evaluated using the I2 index. A bivariate random-effects model calculated pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and 95% confidence intervals (95% CI). Summary receiver operating characteristic curves and area under the curve were analyzed. Sensitivity analysis assessed result robustness.
ResultsTen studies involving 542 patients (720 knee joints) were included. Physical examination showed an area under the curve of 0.88 (95% CI: 0.85–0.91), sensitivity of 0.74 (95% CI: 0.49–0.89), specificity of 0.88 (95% CI: 0.65–0.97), positive likelihood ratio of 6.3 (95% CI: 2.0–19.5), negative likelihood ratio of 0.30 (95% CI: 0.14–0.62), and diagnostic odds ratio of 21 (95% CI: 5–84). Sensitivity analysis confirmed result stability.
ConclusionPhysical examination demonstrates moderate diagnostic accuracy for popliteal cysts. Given the often asymptomatic nature of small cysts and the low clinical burden, physical examination is recommended as a preliminary screening tool when imaging modalities like ultrasonography are unavailable.
Level of evidenceLevel 2, diagnostic meta-analysis based on studies with reference standards.