Advertisement

Joint Line Tenderness and McMurray Tests for the Detection of Meniscal Lesions: What Is Their Real Diagnostic Value?

  • Marco Galli
    Affiliations
    Department of Geriatrics, Neurosciences and Orthopaedics, Teaching Hospital “Agostino Gemelli,” Catholic University of the Sacred Heart School of Medicine, Rome, Italy
    Search for articles by this author
  • Vincenzo Ciriello
    Affiliations
    Department of Geriatrics, Neurosciences and Orthopaedics, Teaching Hospital “Agostino Gemelli,” Catholic University of the Sacred Heart School of Medicine, Rome, Italy
    Search for articles by this author
  • Amerigo Menghi
    Affiliations
    Department of Geriatrics, Neurosciences and Orthopaedics, Teaching Hospital “Agostino Gemelli,” Catholic University of the Sacred Heart School of Medicine, Rome, Italy
    Search for articles by this author
  • Angelo G. Aulisa
    Affiliations
    Department of Orthopaedics, Children's Hospital “Bambino Gesù,” Institute of Scientific Research, Rome, Italy
    Search for articles by this author
  • Alessia Rabini
    Affiliations
    Department of Geriatrics, Neurosciences and Orthopaedics, Teaching Hospital “Agostino Gemelli,” Catholic University of the Sacred Heart School of Medicine, Rome, Italy
    Search for articles by this author
  • Emanuele Marzetti
    Correspondence
    Corresponding author: Emanuele Marzetti, MD, PhD, Dept of Geriatrics, Neurosciences and Orthopaedics, Division of Orthopaedics and Traumatology, Teaching Hospital “Agostino Gemelli,” Catholic University of the Sacred Heart School of Medicine, Largo A. Gemelli 1, 00168 Rome, Italy.
    Affiliations
    Department of Geriatrics, Neurosciences and Orthopaedics, Teaching Hospital “Agostino Gemelli,” Catholic University of the Sacred Heart School of Medicine, Rome, Italy
    Search for articles by this author
Published:November 14, 2012DOI:https://doi.org/10.1016/j.apmr.2012.11.008

      Abstract

      Objectives

      To assess the interobserver concordance of the joint line tenderness (JLT) and McMurray tests, and to determine their diagnostic efficiency for the detection of meniscal lesions.

      Design

      Prospective observational study.

      Setting

      Orthopedics outpatient clinic, university hospital.

      Participants

      Patients (N=60) with suspected nonacute meniscal lesions who underwent knee arthroscopy.

      Interventions

      Not applicable.

      Main Outcome Measures

      Patients were examined by 3 independent observers with graded levels of experience (>10y, 3y, and 4mo of practice). The interobserver concordance was assessed by Cohen-Fleiss κ statistics. Accuracy, negative and positive predictive values for prevalence 10% to 90%, positive (LR+) and negative (LR–) likelihood ratios, and the Bayesian posttest probability with a positive or negative result were also determined. The diagnostic value of the 2 tests combined was assessed by logistic regression. Arthroscopy was used as the reference test.

      Results

      No interobserver concordance was determined for the JLT. The McMurray test showed higher interobserver concordance, which improved when judgments by the less experienced examiner were discarded. The whole series studied by the “best” examiner (experienced orthopedist) provided the following values: (1) JLT: sensitivity, 62.9%; specificity, 50%; LR+, 1.26; LR–, .74; (2) McMurray: sensitivity, 34.3%; specificity, 86.4%; LR+, 2.52; LR–, .76. The combination of the 2 tests did not offer advantages over the McMurray alone.

      Conclusions

      The JLT alone is of little clinical usefulness. A negative McMurray test does not modify the pretest probability of a meniscal lesion, while a positive result has a fair predictive value. Hence, in a patient with a suspected meniscal lesion, a positive McMurray test indicates that arthroscopy should be performed. In case of a negative result, further examinations, including imaging, are needed.

      Keywords

      List of abbreviations:

      JLT (joint line tenderness), LR– (negative likelihood ratio), LR+ (positive likelihood ratio), MRI (magnetic resonance imaging), ROC (receiver operating characteristic)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Konan S.
        • Rayan F.
        • Haddad F.S.
        Do physical diagnostic tests accurately detect meniscal tears?.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 806-811
        • Hing W.
        • White S.
        • Reid D.
        • Marshall R.
        Validity of the McMurray's test and modified versions of the test: a systematic literature review.
        J Man Manip Ther. 2009; 17: 22-35
        • Fowler P.J.
        • Lubliner J.A.
        The predictive value of five clinical signs in the evaluation of meniscal pathology.
        Arthroscopy. 1989; 5: 184-186
        • Kurosaka M.
        • Yagi M.
        • Yoshiya S.
        • Muratsu H.
        • Mizuno K.
        Efficacy of the axially loaded pivot shift test for the diagnosis of a meniscal tear.
        Int Orthop. 1999; 23: 271-274
        • Eren O.T.
        The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears.
        Arthroscopy. 2003; 19: 850-854
        • Malanga G.A.
        • Andrus S.
        • Nadler S.F.
        • McLean J.
        Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests.
        Arch Phys Med Rehabil. 2003; 84: 592-603
        • Evans P.J.
        • Bell G.D.
        • Frank C.
        Prospective evaluation of the McMurray test.
        Am J Sports Med. 1993; 21: 604-608
        • Anderson A.F.
        • Lipscomb A.B.
        Clinical diagnosis of meniscal tears. Description of a new manipulative test.
        Am J Sports Med. 1986; 14: 291-293
        • Solomon D.H.
        • Simel D.L.
        • Bates D.W.
        • Katz J.N.
        • Schaffer J.L.
        The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination.
        JAMA. 2001; 286: 1610-1620
        • Meserve B.B.
        • Cleland J.A.
        • Boucher T.R.
        A meta-analysis examining clinical test utilities for assessing meniscal injury.
        Clin Rehabil. 2008; 22: 143-161
        • Armitage P.
        • Berry G.
        Statistical methods in medical research.
        3rd ed. Blackwell Scientific Publications, Oxford1994
        • Altman D.G.
        Practical statistics for medical research.
        CRC Pr, Boca Raton1996
        • Scholten R.J.
        • Deville W.L.
        • Opstelten W.
        • Bijl D.
        • van der Plas C.G.
        • Bouter L.M.
        The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis.
        J Fam Pract. 2001; 50: 938-944
        • Rose R.E.
        The accuracy of joint line tenderness in the diagnosis of meniscal tears.
        West Indian Med J. 2006; 55: 323-326
        • Hegedus E.J.
        • Cook C.
        • Hasselblad V.
        • Goode A.
        • McCrory D.C.
        Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis.
        J Orthop Sports Phys Ther. 2007; 37: 541-550
        • Corea J.R.
        • Moussa M.
        • al Othman A.
        McMurray's test tested.
        Knee Surg Sports Traumatol Arthrosc. 1994; 2: 70-72
        • Rayan F.
        • Bhonsle S.
        • Shukla D.D.
        Clinical, MRI, and arthroscopic correlation in meniscal and anterior cruciate ligament injuries.
        Int Orthop. 2009; 33: 129-132
        • Kocabey Y.
        • Tetik O.
        • Isbell W.M.
        • Atay O.A.
        • Johnson D.L.
        The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture.
        Arthroscopy. 2004; 20: 696-700
        • Miller G.K.
        A prospective study comparing the accuracy of the clinical diagnosis of meniscus tear with magnetic resonance imaging and its effect on clinical outcome.
        Arthroscopy. 1996; 12: 406-413
        • Rose N.E.
        • Gold S.M.
        A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears.
        Arthroscopy. 1996; 12: 398-405
        • Thomas S.
        • Pullagura M.
        • Robinson E.
        • Cohen A.
        • Banaszkiewicz P.
        The value of magnetic resonance imaging in our current management of ACL and meniscal injuries.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 533-536
        • Shelbourne K.D.
        • Martini D.J.
        • McCarroll J.R.
        • VanMeter C.D.
        Correlation of joint line tenderness and meniscal lesions in patients with acute anterior cruciate ligament tears.
        Am J Sports Med. 1995; 23: 166-169