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. 2019 Jan 21;8(2):e141-e145. A control group was composed of patients with an MRI and intact ACL and FCL. IR of the tibia + Varus stress = lateral meniscus, ER of the tibia + Valgus stress = medial meniscus. Canada. In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. https://www.physio-pedia.com/index.php?title=Lateral_Collateral_Ligament_of_the_Knee&oldid=221054, A direct blow to the anteromedial knee and posterolateral corner, 0: Posteriolateral capsule, arcuate-popliteus complex, anterior and posterior cruciate ligaments, lateral gastrocnemius, 20-30: Posteriolateral capsule, arcuate-popliteus complex, iliotibial band, biceps femoris tendon. Petty NJ. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. ZDIwNGI3MGM0NDMzZmMxM2YxZDdmZWM0YmE5MDI5OWJiMmE4MmFhZTdkODE1 The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. Piantanida, A.N. McMurrays Test - Physiopedia 4th Edition. Saunders. The Management of Sofi Tissue Knee Injuries: Internal Derangements. 24 General examination included carrying angle (normal, valgus,. Kennedy MI, Akamefula R, DePhillipo NN, Logan CA, Peebles L, LaPrade RF. Some studies have attempted to compare the diagnostic value of the McMurray's test to that of modified tests. Three studies used only one tester4,5,25, and two studies did not mention how many examiners were used3,24. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); If you want to assess the integrity of the medial collateral ligament (MCL), check out the Valgus Stress Test of the Knee. The reference lists in review articles were cross-checked and any possibility of name/term variations was queried using MEDLINE and PUBMED. Sensitivity and specificity of a test. Described a modified version (Ege's test) but no description of McMurray's. Address all correspondence and requests for reprints to: Wayne Hing. Limitations of this review relate to the search strategy used. Kurosaka M, Yagi M, Yoshiya S, Muratsu H, Mizuno K. Effcacy of the axially loaded pivot shift test for the diagnosis of a meniscal tear. FOIA Inclusion in an NLM database does not imply endorsement of, or agreement with, PMC Bhandari M, Guyatt GH. While palpating the lateral joint line, the examiner should apply a varus force to the patient's knee. The review also highlights the idea that modified versions of the test seem to be more valid than the original version. ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz 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. As previously documented in the literature10, the definition and calculation of statistical measures of concurrent criterion-validity are based on the absence or agreement between the clinical test and the gold standard test. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Lateral Collateral Ligament of the Knee - Physiopedia A consensus method was used to discuss and resolve discrepancies between the markings of each paper between the three reviewers. J Sport Rehabil. The inclusion of patients with different pathologies would make the results of studies more generalizable to the clinical setting. 2nd ed. There . National Center for Biotechnology Information ZDg0M2Q2NDY1ZmIyNjFkZjBiOWE0MzQ3ZjJhZTY1NmRmYTUwYTBiMTNkNTIz Likelihood Ratio +/-. DOI https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2. Painful conditions of the knee, inPain Management Vol 1.,2007. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh Use of methodological standards in diagnostic test research: Getting better but still not good. Described a modified version (Medial-Lateral Grind test) but no description of McMurray's. $ is the truncation character. Three of these studies had fairly broad inclusion criteria that better reflect the population seen in clinical practice with two including subjects with suspected meniscal or ligamentous pathology6,19; the study by Sae-jung et al24 included any patients identified as needing arthroscopy. Interactive Content (Direct Video Demonstration, PubMed articles), Statistical Values for all Special Tests from the latest research, Currently on Version 6.0 Free lifetime updates. Differences in the type of tear have been suggested as influencing the result of clinical tests; however, no detailed investigation of this issue exists in the current literature3. Diagnosis of acute knee ligament injuries: The value of stress radiography compared with clinical examination, stability, under anesthesia and arthroscopic or operative findings. Fowler PJ, Lubliner JA. Studies looking at diagnostic accuracy, sensitivity and specificity have demonstrated varied values. The proportion of people who test negative and who do not have the disease or dysfunction. 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. [4] The popliteus tendon is deep to the LCL, seperating it from the lateral meniscus. Epub 2017 Aug 16. Varus stress radiographs were determined to be more sensitive in diagnosing FCL injuries compared with MRI, with an overall sensitivity of 70% compared with 66%, respectively. Statistical evaluation of McMurray's test in the clinical diagnosis of meniscus injuries. Fritz JM, Wainner RS. Whenever suspecting a posterolateral complex injury, one has to carefully perform a valgus stress test in 0 degrees and 30 degrees. For the varus stress test, the patient is in supine position and asked to relax. The majority of studies did not report intertester or intratester reliability of the McMurray's test. The assessment results for methodological quality has been presented under the following headings: the STARD analysis, reference standard, population differences, blinding, description and interpretation of test, inter-tester reliability, diagnostic accuracy and validity, sensitivity and specificity, likelihood ratios, and McMurray's test compared to modified versions of the test. Sensitivity and specificity values infer the probability of a correct test, given the result of the reference standard11. Evans et al23 demonstrated a low level of agreement between the two examiners with intertester agreements ranging from poor for reproduction of a medial sensation (Kappa = 0.10) to fair (K = +0.38) for lateral pain. How to appraise a diagnostic test. eCollection 2019 Feb. Based on chronicity of the injuries, MRI was more accurate for detecting acute FCL injuries than chronic injuries (P = .002), and varus stress radiographs were more accurate for detecting chronic FCL injuries than acute injuries (P = .041). official website and that any information you provide is encrypted In total, 11 studies have been included in this critical review. [8]The test has therefore often been reported to be of limited value in current clinical practice. That is usually the journal article where the information was first stated. [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. 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. With regard to negative likelihood ratios, all but three of the studies demonstrated only a small alteration in probability that a subject with a negative McMurray's test will not have a meniscal tear (Table (Table5).5). The accuracy measure has limited usefulness in that it does not distinguish between the diagnostic value of positive and negative results11. The sensitivity of a test reflects the proportion of people with the disease in question who are tested positive, whereas the specificity is the proportion of those without the disease who are tested negative. 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. Accessibility Medline and CINAHL search strategy via OVID. YzZhYjViODEyOTFlYzkyIn0= Elbow Valgus Stress Test 2023 | OrthoFixar Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. Performing the Test: The patient's leg should be relaxed for this test. Malanga GA, Andrus S, Nadler SF, McLean J. Merriman L, Turner W. Assessment of the Lower Limb. The final study by Sae-Jung et al24 compared a modified version to McMurray's added axial compression, similar to that applied by Kurosaka et al6 but without added valgus or varus stress. Arthrosc Tech. 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. Studies were also not examined where they clearly did not meet the search criteria. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. . Further, the description of the test itself should be well explained, and improving intertester reliability in the future would increase the validity of the studies. 2001;177(2):409413. The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. Acute patients (< 6 weeks) excluded. Under the original description of the test, a thud or a click felt by the examiner (and sometimes heard) while performing the test was considered positive (McMurray as cited in Corea et al4). Level II, case-control study. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Three studies in this review compared the McMurray's test to modified versions that incorporated the added components of varus/valgus stress and axial compression. Generated by Wordfence at Mon, 1 May 2023 20:49:59 GMT.Your computer's time: document.write(new Date().toUTCString());. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); We use cookies to optimize our website and our service. Valgus Stress Test The ligament lies laterally and posteriorly along the joint line. Federal government websites often end in .gov or .mil. 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. NTc3ODRiOTRjOGU4N2ExOGU2NDEzYWVjZmNiMTQ1N2FjM2U4NjVmMzhlMzRi Orthopaedics - A guide for practitioners. Bookshelf 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. They commented that the lack of intertester agreement may have been due to differences in the amount of force produced. Copyright 2018 Arthroscopy Association of North America. Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. Additionally, the single photon-emission CT scan is receiving a lot . Philadelphia: Elsevier, 2016; 2121-2297. Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears. Physical Examination of the Knee | Musculoskeletal Key Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. Powell JW, Huijbregts PA. Concurrent criterion-related validity of acromioclavicular joint physical examination tests: A systematic review. Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality A recent meta-analysis reports sensitivity and specificity to be 70% and 71%. These authors demonstrated significantly larger (better) positive likelihood ratios and significantly smaller (better) negative likelihood ratios than the McMurray's. followers, 712k 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. These authors excluded subjects with clinical or radiographic evidence of arthritis or fracture that would increase the accuracy of testing but decrease the generalizability of the findings. Saunders Elsevier. Useful tests should produce large shifts in probability once the result of the test is known. Generally, the McMurray's test has relatively high specificity and low sensitivity. A recent evidence-based guideline for the management of acute soft tissue injuries to the knee has recommended that joint line tenderness is the only reliable clinical indicator of meniscal pathology2. . The examiner should passively bend the affected leg to about 30 degrees of flexion. 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. Each test is repeated with the knee in full extension. To some degree, this is achieved by sensitivity and specificity, which provide useful information for interpreting the results of diagnostic tests. Varus Test | Special Tests Consecutive patients suspected of having meniscal tears presenting for arthroscopy: acute and chronic (ligament injuries excluded). Orthopedic Physical Assessment: 5 th Edition. Mariani et al30 have suggested that the differences in anatomical attachments of the two menisci contribute to these variations in sensitivity and specificity of diagnostic tests30. However, if positive findings are grouped with positive findings from other tests, such as joint line tenderness and Apley's test, the test may be more valid. [3] McClure P,W et al. 2017 Mar;101(Suppl 1):23-35. doi: 10.1007/s12306-017-0460-5. 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. ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. NWI4Njg2Y2FiM2QzZGFjNjA2MjRhYTcxMTY2NmVkZmYzNTMwZDdiNTk4YTcy Limits human and English. Take the leg and bring it in 30 Flexion (MLPP) and use a cushion or edge of the bed so the patient can relax. Clinical diagnosis of meniscal tears: Description of a new manipulative test. Excluding any with past history of trauma and any with associated fractures, serious arthrosis, previous history of knee surgery or discoid meniscus identified arthroscopically. Baker PE, Peckham AC, Pupparo F, Sanborn JC. An official website of the United States government. Physical examination tests for assessing a torn meniscus in the knee: A systematic review with meta-analysis. The importance of the valgus stress test in the diagnosis of - PubMed Would you like email updates of new search results? Evans et al23 used consecutive patients on a waiting list for arthroscopy for a variety of conditions including, but not limited to, suspected meniscal tears. Knee, McMurray's, Meniscal, Reliability, Sensitivity, Specificity, Testing, Validity. Referred from GP/A&E with suspected cruciate ligament or meniscal pathology. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi Fibular collateral ligament and the posterolateral corner. Place the affected leg in extension and slight external rotation. Bossuyt PM, Reitsma JB, Bruns DE, et al. Each of these studies demonstrated improved diagnostic accuracy of these modified tests compared to the original McMurray's; however, they concluded that the modified tests should be used as well, as rather than as an alternative to other diagnostic tests3,5,6. Unlike the medial meniscus, which is attached to the medial ligament, the lateral meniscus is not attached to the lateral ligament. YjQ3NDViZGE1YWVjODEwNTIzYzIyMmY1YjViMDhhNGI3Y2YyNTI4NmMwMjli There is conflicting evidence in the literature over the accuracy of MRI. Rose NE, Gold SM. The most sensitive test used in the diagnostics of medial meniscus lesions was the McMurray test, which showed a sensitivity of 87.5% with 52% specificity. Sae-Jung S, Jirarattanaphochai K, Benjasil T. KKU knee compression-rotation test for detection of meniscal tears: A comparative study of its diagnostic accuracy with the McMurray test. Studies by Boeree and Ackroyd19, Akseki et al3, and Karachalios et al21 demonstrated small but sometimes important shifts in probability. 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. With a sensitivity of 86% and a specificity of 95%, . The accurate diagnosis of meniscal pathology on the basis of the findings of such tests is often difficult. An LR+ indicates the degree of certainty that a patient with a positive test actually has the suspected condition while an LR indicates the degree of certainty that a patient with a negative test does not have the suspected condition27. I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). Boeree NR, Ackroyd CE. Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. Future research should concentrate on building a strong methodological base incorporating large samples of consecutive patients with commonly confused pathologies. 8600 Rockville Pike Varus Test Of The Knee 2023 | OrthoFixar Currently, a triple phase technium-99 bone scan (scintigraphy) is the most accurate method of diagnosing stress fractures with a sensitivity of 100% and specificity of 76%. This review identified that the McMurray's test is of limited clinical value due to relatively low sensitivity, with modified tests (associated with the traditional McMurray's test) having higher diagnostic accuracy and thus these may be more useful clinically. Original description. ZTY2MWNjMWEzNTQ3MTc4OGU3ZWFmY2NhNWFkNDczMWFlOGI3ZDgwMTBkOGFj This an indication of a LCL tear. 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. Although the support of a clinical study is needed in order to make a definite conclusion, the dial test is probably not reliable in the presence of medial instability, Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article).
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