A meta-analysis evaluates the diagnostic accuracy of physical examination in popliteal cysts, common cystic lesions of the knee that are often asymptomatic and a risk factor for osteoarthritis. It included ten studies with 542 patients (720 knee joints), searched in PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases until November 30, 2025. Study quality was assessed by the QUAD tool, heterogeneity by the I² index, and results calculated by a bivariate random effects model. Physical examination achieved an area under the curve of 0.88 (95% CI: 0.85–0.91), sensitivity 0.74 (95% CI: 0.49–0.89), specificity 0.88 (95% CI: 0.65–0.97), positive likelihood ratio 6.3, negative likelihood ratio 0.30 (95% CI: 0.14–0.62) and a diagnostic odds ratio of 21 (95% CI: 5–84). The sensitivity analysis confirmed the stability of the results. Physical examination has demonstrated moderate diagnostic accuracy and is recommended as a preliminary screening tool when imaging modalities such as ultrasonography are not available. Level of evidence is 2 (diagnostic meta-analysis based on studies with reference standards).