An official website of the United States government. Sensitivity and specificity values fail to do this11. Bossuyt PM, Reitsma JB, Bruns DE, et al. Review of meniscal injury and associated sports. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. 1st ed. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh eyJtZXNzYWdlIjoiMDAzMWIwNTU1ZDk0ZjIzMGU1NDkwYzhmOWYxZTk0YWI3 Gursoy S, Perry AK, Dandu N, Singh H, Vadhera AS, Yanke A, LaPrade RF, Chahla J. Orthop J Sports Med. Harilainen A. Patients who underwent arthroscopy to assess suspected meniscal or meniscal together with ACL injuries. Specificity: 100% Valgus Stress Test: Sensitivity: 91% Specificity: 17% Varus Stress Test: Sensitivity: 25-77% Specificity: 98-99% Quadriceps Active Test: Sensitivity: 54-99% Specificity: 97-100% Posterior Sag Test: Inconclusive. Epub 2017 Feb 14. ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 The wide range of positive likelihood ratios (0.828.86) make it difficult to draw any conclusions about the actual magnitude of this ratio. The results support the use of both varus stress radiographs and MRI in diagnosing FCL injuries, because MRI is more sensitive in diagnosing an acute FCL tear, and varus stress radiographs are more sensitive in diagnosing a chronic FCL tear. [1]. The test is fairly solid. As a stand-alone test, it had a sensitivity of 78% and specificity of 67% the pain was used as the outcome measure and a sensitivity of 91% and specificity of 49% when laxity was the outcome measure. Based on the STARD scoring of each paper, it is possible to make a qualitative assessment about the methodological quality. Human Kinetics, 2008. The other hand provides a varus stress to the ankle. Orthopaedics - A guide for practitioners. [8], Mechanism of injury: (for more information, see the page on LCL injuries)[4], Patient position: Legs crossed with ankle resting on opposite knee (90 knee flexion, hip abduction and external rotation). Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw The preliminary nature of this tool also means that a more narrative review of the validity and accuracy of the tests has been presented. Ocassionally, the LCL is congenitally absent. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). Before How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt. The purpose of this paper was to assess the literature investigating the validity and diagnostic accuracy of the McMurray's test (and modifications) for determining meniscal pathology of the knee so that conclusions could be drawn regarding its clinical usefulness as a test. Consecutive patients. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. Whenever suspecting a posterolateral complex injury, one has to carefully perform a valgus stress test in 0 degrees and 30 degrees. In total, 11 studies have been included in this critical review. Study with Quizlet and memorize flashcards containing terms like Ballottement, Valgus Stress Test, Varus Stress Test and more. Background and Objectives: Clinically, it is beneficial to determine the knee osteoarthritis (OA) subtype that responds well to conservative treatments. One problem with these modified tests is that they appear to have all been evaluated by the creators of the tests, which to some degree challenges the validity of the research. While it is difficult to compare results across studies due to the differences in the tests being used, the results of this review appear to show that the modified tests have higher diagnostic value than the McMurray's test. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears. The proportion of people who do not have the disease or dysfunction who test negative. Disclaimer. Conclusions: Usually medial angulation of both femur and tibia is involved. Table Table55 shows the LR+ and LR for the 11 studies included within this review with 95% CIs. PMC Results: followers. YmQ4NDJhMzZkOWUyMDUwNzAxN2M3ZjVhOGYyYmU0ZDVkYWUxNWM0ZGFhMTFi HHS Vulnerability Disclosure, Help As the knee goes into flexion, the LCL loses its significance and influence as a varus-stabilizing structure. Painful conditions of the knee, inPain Management Vol 1.,2007. In chronic injuries, this test has a sensitivity of 92% and a specificity of 91%, but not in acute injuries. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. Sensitivity is the probability of a positive test result in someone with the pathology, whereas specificity is the probability of a negative test result in someone without the pathology.6Traditionally, tests which have high sensitivity values are able to correctly identify individuals with the pathology; thus, if the examiner obtains a negative Valgus Stress Test. Likelihood ratios overcome some of the problems involved with sensitivity and specificity values by summarizing the information contained in these values in a manner that can be used to quantify shifts in probability once the meniscal test results are known28. Although six studies used multiple testers, these did not provide statistics for reliability6,1923. The accurate diagnosis of meniscal pathology on the basis of the findings of such tests is often difficult. All abstracts for 44 articles from Medline, 19 articles from CINAhL, 5 articles from AMED, 18 articles from SPORTSDiscus, 548 articles from SCOPUS, and 6 articles from the hand search were reviewed by the authors (Figure (Figure2).2). That is usually the journal article where the information was first stated. There is conflicting evidence in the literature over the accuracy of MRI. Evidence-Based Medicine: How to Practice and Teach EBM. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. Corea JR, Moussa M, Al Othman A. McMurray's test tested. Federal government websites often end in .gov or .mil. Akseki et al3 compared the McMurray's test with a weight-bearing version of the McMurray's test that incorporated axial compression and varus/valgus stress, with the patient squatting down in internal and then external rotation (Ege's test). Jaeschke RZ, Meade MO, Guyatt GH, Keenan SP, Cook DJ. YWQ2ODI0ODM5NzE5MzVlYTlmMTRmMWEzM2NlYmU4OTViYTkwOTBmNjVjZGFj NDkyMTlmYzMyYjdlN2RlZTQ2MjFiMjc5NGRhOWNjYWI3NTliM2NhYzM3YWNj H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). MGY4MmExODg4MDUwZTk2NzUzNjQ0OTMxYjkxN2QwYjQ5MmMxODdmMWU4MDdi Five studies compared modified versions of the test to McMurray's3,5,6,21,24 (Table (Table33). Performed at 900 of knee flexion, and has a sensitivity of 90% and a specificity of 99% Isolated PCL translate > 10-12mm in neutral and >6-8mm in internal rotation. Purpose: The varus stress test shows a lateral joint line gap. In most cases Physiopedia articles are a secondary source and so should not be used as references. Pg 791. how likely a negative test result is in people who have the disease or dysfunction as compared to how likely it is in those who do not have the disease or dysfunction. Irwig L, Tosteson AN, Gatsonis C, et al. However, for medial meniscal tears, rates are lower. Anterior cruciate ligament reconstruction: MR imaging findings. This trade-off between sensitivity and specificity makes it important that they be considered jointly27. Clinical assessment of meniscal pathology in the knee has proven difficult due to the wide number of tests available and variations in their interpretation and application. Valgus and Varus test of the knee can be graded by the following 1: Grade I: The joint space opening is within 2 mm of the contralateral side. Cinque ME, Geeslin AG, Chahla J, Moatshe G, Pogorzelski J, DePhillipo NN, LaPrade RF. Copyright 2018 Arthroscopy Association of North America. any of these symptoms can indicate a compromised medial or lateral meniscus. Some studies have attempted to compare the diagnostic value of the McMurray's test to that of modified tests. Patients diagnosed with meniscal lesions (based on symptoms including pain, recurrent edema, giving way, joint clicks, or block to movement) having arthroscopic surgery. [8]The test has therefore often been reported to be of limited value in current clinical practice. This means that tests rarely have both high sensitivity and specificity. LaPrade RF, DePhillipo NN, Cram TR, Cinque ME, Kennedy MI, Dornan GJ, O'Brien LT. Am J Sports Med. An assessment for one-plane lateral instability (i.e. Am J Roentgenol. Bethesda, MD 20894, Web Policies The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. Based on MRI, overall specificity was 68%. National Library of Medicine MRI has also shown to be highly reliable, but due to its expensive cost, they are less frequently used. A recent study by Winters and Tregonning13 showed a diagnostic accuracy for MRI to be 90% for the medial meniscus and 82% for the lateral meniscus. In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. [1] Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1. McMurray clearly indicated that the test that bears his name is only relevant for tears in the posterior portion of the cartilage (McMurray, 1942, cited in Corea et al4). Canada. Enroll in our online course: http://bit.ly/PTMSK DOWNLOAD OUR APP: iPhone/iPad: https://goo.gl/eUuF7w Android: https://goo.gl/3NKzJX GET OUR ASSESSMENT B. Piantanida, A.N. A recent study by Akseki et al3 reported high combined sensitivity and specificity figures (63% and 83%, respectively) and relatively narrow confidence intervals (Table (Table5).5). Consider reproduction of pain during the test as a positive test, not just the reproduction of a. St. Louis, MO: Saunders Elsevier;2008. Epub 2018 Jul 17. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. The best statistics for summarizing usefulness of a diagnostic test appear to be likelihood ratios (LR)17. MR imaging of meniscal cysts: incidence, location, and clinical significance. These results have been supported by Karachalios et al21, who compared another weight-bearing modification (the Thessaly test) of the McMurray's with the original test. High sensitivity indicates that a test can be used for excluding a condition when it is negative, but it does not address the value of a positive test. The lower the LR, the more certain you can be that a negative test indicates the person does not have the disorder11 (Table (Table6).6). Likelihood Ratio +/-. Obviously, if the test is performed differently and/or the interpretation of a positive test is not the same, the demonstrated accuracy of the test cannot be compared. Unauthorized use of these marks is strictly prohibited. Physical examination consisted of general elbow examination and specific examination of the distal biceps based on literature. Finally, further independent research needs to compare the McMurray's test with modified tests to confirm the apparent superiority of these tests over the McMurray's test. In contrast, the paper by Sae-Jung et al24 found sensitivity for medial and lateral menisci of 70% and 68%, respectively, and specificity values for medial and lateral menisci of 60.7% and 47.8%, respectively. Sackett D, Richardson S, Rosenberg W, Haynes RB. Saunders. Also described a modified version (the KKU compression-rotation test), Medial & Lateral combined = meniscal tear, Generate large and often conclusive shifts in probability, Generate small but sometimes important shifts in probability, Alter probability to a small and rarely important degree. YmRhYTcyZWFhNTQ5OTM0YWYwODRjZDU1OWU3ZjBjNmMyMjA4NTcxZTRmMDYw Evaluation of Knee Instability in Acute Ligamentous Injuries. [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. Sensitivity: 25% . Three of the studies in this review considered a positive test to be the reproduction of a palpable thud or click4,6,22 (Table (Table4).4). Knee injuries. There . However, this provisional diagnosis was also based on other symptoms that one might consider could be associated with pathologies other than meniscal tears, e.g., pain, recurrent effusion, muscle wasting, and instability. The site is secure. Whiting WC, Zernicke RF. In: DeLee & Drez's Orthopaedic Sports Medicine. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). Based on MRI, overall specificity was 68%. (2007)Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. The objective of this paper was to critically review the literature with respect to the validity and diagnostic accuracy of the traditional McMurray's test and any modifications of this test. YzA0Nzk1ZjQxYjY5Mzg4MWUwNDRlODM0NDRiNzZiM2I4OWVhNTQ1YmVlMDNj Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. The incidence of LCL injuries are relatively low (6%) when compared to other knee injuries. ZDg0M2Q2NDY1ZmIyNjFkZjBiOWE0MzQ3ZjJhZTY1NmRmYTUwYTBiMTNkNTIz Studies were eligible for inclusion if they assessed measures of accuracy or validity of the McMurray's test or any modification of this test against a gold standard of either arthroscopy or magnetic resonance imaging (MRI) and were written in English. = (Number of TP + Number of TN)/(Numbers of TP + FP + FN), Identifies article as a study of diagnostic accuracy, Describes study population (inclusion criteria, exclusion criteria, settings, locations), Describes data collection (prospective or respective), Describes reference standard and rationale, Describes technical Specifications of material and methods involved, Describes definition and rationale of units, cut-of points, or categories of results of tests, Describes number, training, and expertise of raters. However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. Be aware of the validity issues surrounding this test. Six of the studies within this review included consecutive patients (Table (Table4).4). Sensitivity and specificity of this test are only 38% and 41%, respectively. Although sensitivity and specificity values provide useful information, they work against the direction of clinical testing11. The reliability of this test in extension is 68% and in 30 flexion only 56%. 1. 76, No. These authors demonstrated significantly larger (better) positive likelihood ratios and significantly smaller (better) negative likelihood ratios than the McMurray's. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the fiessaly Test) for early detection of meniscal tears. Original description. Although these authors mentioned that the examiners were blinded to the results of the MRI, they did not make it clear if the examiners knew that there were a similar number of normals and symptomatic subjects included in the study or if they knew which group each individual subject belonged to. Limiting the search to English language articles only may also have led to an omission of other relevant studies. followers, 712k Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. M2MwN2QyM2QzMGFjZjQ3MDgzMGRiYzAyMmRlZDc3MTAxODc4MDdhNzcyZWMz The four possible outcomes include true positive, a false positive, a false negative, and a true negative (see Table Table2).2). [11] Sensitivity: 25% . Clinical Rehabilitation, 22(2), 143-61. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. FOIA In order to make the retrieval of articles as comprehensive as possible, a generic search strategy was employed using Medline, CINAhL, and AMED databases through OVID, SPORTDiscus database through EBSCO, and SCOPUS, from 1980 to May 2008. Four studies demonstrated that a positive test alters the probability to only a small, rarely important degree5,6,25, suggesting uncertainty that a positive test will indicate meniscal pathology (Table (Table5).5). Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is unlocked.1. Generated by Wordfence at Mon, 1 May 2023 20:49:59 GMT.Your computer's time: document.write(new Date().toUTCString());. Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. Studies by Boeree and Ackroyd19, Akseki et al3, and Karachalios et al21 demonstrated small but sometimes important shifts in probability. ZDZkZjczMGZkNzQ1OWMxZTQyNDY2ZTAzYTM5OTk2ZmQ1YjkzNDFjMDhmNzMy Grade III: The joint space opens 5 . Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes. A) AND B): The McMurray's test: Figure 1a) the tibia rotated on the femur into full internal rotation and Figure 1b) the tibia rotated on the femur into full external rotation. One of the tests was the valgus stress test, particularly at 30 of knee flexion. The test is first done with the knee in full extension and then with the knee in 20-30 degrees of flexion. In an analysis of 20 available studies, the mean sensitivity and specificity of the anterior drawer test were 38% to 81% in awake patients and 63% to 91% in anesthetized patients, respectively. Relatively narrow confidence intervals also attest to the reliability of these two studies3,4 (Table (Table55). Petty NJ. A total of 232 patients were included: 98 patients in the FCL tear group (mean age: 33.6 12.2 years) and 134 patients in the control group (mean age: 44.0 17.2 years). Fibular collateral ligament and the posterolateral corner. 8600 Rockville Pike One of the search terms used was McMurray$ test$. The same maneuvers are performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the menisci. It is performed by placing the knee beyond 90 of flexion and then rotating the tibia on the femur into full internal rotation to test the lateral meniscus, or full external rotation to test the medial meniscus. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi Posterior drawer test Posterior sag test (godfrey test) Quadriceps active test Dial test Varus/valgus stress . Consecutive patients awaiting elective arthroscopy for suspected meniscal or other conditions based on history and physical examination.