Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. Walters J, editor. 1987; 76: 269-273. Kane PW, Cinque ME, Moatshe G, Chahla J, DePhillipo NN, Provencher MT, LaPrade RF. DOI https://doi.org/10.1016/C2009-1-59662-1. The sensitivity and specificity of the clinical tests and magnetic resonance (MR) imaging are reviewed because these parameters vary, and an understanding of the diagnostic utility of both the clinical and imaging tests is important in accurately formulating a definitive diagnosis. Miller GK. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. Consecutive patients clinically diagnosed as having torn menisci (based on symptoms of pain, locking, painful clicks, recurrent effusions, giving way or signs of extension block, wasting, or instability) Patients with evidence of fracture or arthritis, a previous history of surgery, or with an acute locked knee or haemarthrosis were excluded. YmQ4NDJhMzZkOWUyMDUwNzAxN2M3ZjVhOGYyYmU0ZDVkYWUxNWM0ZGFhMTFi ZmZjN2MzNzdhZDFlZWY2OGI0YWExNTViZjA5ZDc3OTA3MTJmYTYyOGFmMGEw 1985;13(1):14. Unlike the medial meniscus, which is attached to the medial ligament, the lateral meniscus is not attached to the lateral ligament. Authors of 9 studies examined the Lachman test and reported sensitivity values ranging from 0.63-0.93 and specificity values ranging from 0.55-0.99. The accuracy of the clinical knee examination documented by arthroscopy: A prospective study. The test is performed at 0 and 20-30, so the knee joint is in the closed packed position. Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. A prospective study comparing the accuracy of the clinical diagnosis of meniscal tears with magnetic resonance imaging and its effect on clinical outcome. 2008. How to appraise a diagnostic test. Clinical diagnosis of meniscal tears: Description of a new manipulative test. In chronic injuries, this test has a sensitivity of 92% and a specificity of 91%, but not in acute injuries. Cape Town: University of Cape Town, 2010. Sensitivity and specificity rely on a single threshold for classifying a test result as positive or negative. Sensitivity and specificity values fail to do this11. Varus Test Of The Knee 2023 | OrthoFixar Three studies used only one tester4,5,25, and two studies did not mention how many examiners were used3,24. Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. HHS Vulnerability Disclosure, Help Painful conditions of the knee, inPain Management Vol 1.,2007. The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). Consider the findings of this test in conjunction with those of other tests to enhance the likelihood of a correct diagnosis such as joint line tenderness. Bethesda, MD 20894, Web Policies Sensitivity figures were higher than specificity for three studies5,20,25 (Table (Table5).5). Comparison of likelihood ratio's for McMurray's test with modified tests. IR of the tibia + Varus stress = lateral meniscus, ER of the tibia + Valgus stress = medial meniscus. Specificity: not reported. When pooled together using the bivariate random effects model (BREM), the sensitivity value of the 8 studies was 0.2 and the specificity value was 0.88. The low sensitivity figures would indicate that in general, a negative test result is not reliable in ruling out meniscal pathology and a torn meniscus would likely be missed if the McMurray's test was the sole determinant of pathology. What are sensitivity and specificity? | Evidence-Based Nursing Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. Physical Examination of the Knee | Musculoskeletal Key 4th ed. [2] Harilainen A. Interpretation: If the knee joint adducts greater than normal (compared to the unaffected leg), the test is positive. Place the affected leg in extension and slight external rotation. This, along with the conclusions discussed above, suggests that the McMurray's test should be used as one of a combination of tests in the clinical setting3,22,23. Although sensitivity and specificity values provide useful information, they work against the direction of clinical testing11. Bethesda, MD 20894, Web Policies The final two studies20,21 limited their study population to patients suspected of meniscal injury. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Medicina | Free Full-Text | Valgus Arthritic Knee Responds Better to The description of a test within a study should be sufficient to enable replication of the test by practitioners and subsequent researchers. NjZjMWViMWE5MzNlMDFhOTA3YzAwYzUzODYzZmQyZGI2ODk1ZmJlOGM4YzZh This an indication of a LCL tear. 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. Kurosaka et al6 took the modification of the Medial-Lateral Grind test further by comparing the McMurray's test to a pivot shift test that not only had a component of varus/valgus stress but also included a component of axial loading. It is important to take this into consideration when analyzing test results of studies that have used more than one examiner. Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. In addition, cited references of relevant articles were examined. Take the leg and bring it in 30 Flexion (MLPP) and use a cushion or edge of the bed so the patient can relax. The test is first done with the knee in full extension and then with the knee in 20-30 degrees of flexion. As is true of all statistics, sensitivity and specificity values are taken from a sample and represent an estimate of the true value that could be found in the population. Purpose: The varus stress test shows a lateral joint line gap. MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. The confidence interval (CI) attests to the precision of this estimate11. Unauthorized use of these marks is strictly prohibited. HHS Vulnerability Disclosure, Help Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. Clinically, we do not know whether a patient has the condition before the diagnostic test (arthroscopy or MRI) is performed. Churchill Livingstone, 2002. YWQ2ODI0ODM5NzE5MzVlYTlmMTRmMWEzM2NlYmU4OTViYTkwOTBmNjVjZGFj Epub 2018 Jul 27. Muellner T, Weinstabl R, Schabus R, Vecsei V, Kainberger F. The diagnosis of meniscal tears in athletes: A comparison of clinical and magnetic resonance imaging investigations. M2NhODMyZGZjNTEwMzAzY2JkMWI0MTUwM2I3NjNjN2RjYmY4NmEyNWE1ZjZk . Kurosaka et al6 stated that diagnostic accuracy is lessened in patients with multiple pathologies, whereas Akseki et al3 found that there was no reduction in diagnostic accuracy with an associated tear of the ACL. 2001;177(2):409413. 2017 Dec;33(12):2177-2181. doi: 10.1016/j.arthro.2017.06.028. Valgus Stress Test. 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. Accuracy is the percentage of subjects who are correctly identified as either having or not having a meniscal tear. 1st ed. Usually medial angulation of both femur and tibia is involved. 24 General examination included carrying angle (normal, valgus,. Oberlander MA, Shalvoy RM, Hughston JC. eyJtZXNzYWdlIjoiMDAzMWIwNTU1ZDk0ZjIzMGU1NDkwYzhmOWYxZTk0YWI3 YmRhYTcyZWFhNTQ5OTM0YWYwODRjZDU1OWU3ZjBjNmMyMjA4NTcxZTRmMDYw YzQ2ZWY3MDkyMmRjMWVjYzY3ODhjNTExZjU4NGIzMTJjNjA3ZDA5Mzk3NTFl 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). These authors also observed that the studies on these new tests have only been subjected to scientific scrutiny on one occasion and further research is required on these tests. Test Position: Supine. The test is fairly solid. Sensitivity figures vary from 16%88%, while specificity figures vary from 20%98% (Table (Table5).5). Analysis of the quality of studies that evaluate the validity and accuracy of tests, such as the McMurray's test, is difficult if key information regarding the design, conduct, and analysis of the study are not reported by the authors9. MDYzNWEzNGQxNDFiMmU0MDBmMmJkZTU4YzNiNzE1MWYxNWM3ZGU1NzFkM2Zm ZTE1ZTU0YzgxZTBhZGFlNGI5YzcyODQ4YjdhNTE5Yzc0MmMzMTI2YmQ5M2E1 Please enable it to take advantage of the complete set of features! The remaining studies do not clearly state if their subjects were consecutive. Would you like email updates of new search results? Valgus and Varus Stress Test [1] Magee DJ. When confidence intervals are not present, the CIs were incalculable due to absence of raw data. Careers. Disease paper 2 .pdf - Jade Smith BIOL 2301 Sec. 001 Consecutive patients awaiting elective arthroscopy for suspected meniscal or other conditions based on history and physical examination. When refering to evidence in academic writing, you should always try to reference the primary (original) source. [3] McClure P,W et al. True positive: the person has the disease and the test is positive. Bossuyt PM, Reitsma JB, Bruns DE, et al. PDF ssslideshare.com Does the patient have a torn meniscus of ligament of the knee? 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. In general, sensitivity figures are much lower than specificity and the CI limits are wider. The LCL acts as a secondary stabilizer to anterior and posterior tibial translation when the cruciate ligaments are torn. $ is the truncation character. Limitations of this review relate to the search strategy used. 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. 1, This website is powered by SportsEngine's. Collectively, these studies indicate that there is little consensus in the reported measures of validity of the McMurray's test and that this is mostly due to limitations in the methodological quality of the studies that were assessed. Arthroscopy. Karachalios et al21 incorrectly added valgus or varus stress as a component of the McMurray's. Of the 11 studies identified in this review, nine used arthroscopy as the reference standard, one used MRI, and the remaining study used both MRI and arthroscopy (Table (Table44). Unable to load your collection due to an error, Unable to load your delegates due to an error. LaPrade RF, DePhillipo NN, Cram TR, Cinque ME, Kennedy MI, Dornan GJ, O'Brien LT. Am J Sports Med. ZTU5MGVlOWM4MDcwMGE2YmJiZjNjZTBiMjQ2N2E5OTFmNTliZDgyYzc4ZjQ0 In most cases Physiopedia articles are a secondary source and so should not be used as references. Consequently, it is likely that the accuracy of meniscal testing demonstrated by this study is artificially high compared to studies with a wider inclusion criteria.