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
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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.
