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 accessOne-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 RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Do physical diagnostic tests accurately detect meniscal tears?.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 806-811
- Validity of the McMurray's test and modified versions of the test: a systematic literature review.J Man Manip Ther. 2009; 17: 22-35
- The predictive value of five clinical signs in the evaluation of meniscal pathology.Arthroscopy. 1989; 5: 184-186
- Efficacy of the axially loaded pivot shift test for the diagnosis of a meniscal tear.Int Orthop. 1999; 23: 271-274
- The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears.Arthroscopy. 2003; 19: 850-854
- 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
- Prospective evaluation of the McMurray test.Am J Sports Med. 1993; 21: 604-608
- Clinical diagnosis of meniscal tears. Description of a new manipulative test.Am J Sports Med. 1986; 14: 291-293
- 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
- A meta-analysis examining clinical test utilities for assessing meniscal injury.Clin Rehabil. 2008; 22: 143-161
- Statistical methods in medical research.3rd ed. Blackwell Scientific Publications, Oxford1994
- Practical statistics for medical research.CRC Pr, Boca Raton1996
- The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis.J Fam Pract. 2001; 50: 938-944
- The accuracy of joint line tenderness in the diagnosis of meniscal tears.West Indian Med J. 2006; 55: 323-326
- 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
- McMurray's test tested.Knee Surg Sports Traumatol Arthrosc. 1994; 2: 70-72
- Clinical, MRI, and arthroscopic correlation in meniscal and anterior cruciate ligament injuries.Int Orthop. 2009; 33: 129-132
- 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
- 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
- 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
- The value of magnetic resonance imaging in our current management of ACL and meniscal injuries.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 533-536
- Correlation of joint line tenderness and meniscal lesions in patients with acute anterior cruciate ligament tears.Am J Sports Med. 1995; 23: 166-169
Article info
Publication history
Published online: November 14, 2012
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.