Sensitivity figures vary from 16%88%, while specificity figures vary from 20%98% (Table (Table5).5). ZmNhYzI5Njc5MTEwZGU2NTAzYmRjNmJiODlmMmU0N2FhYzFhMDRjNjQ1YTNk Am J Roentgenol. These represent small but sometimes important shifts in probability and the stronger methodology of these studies is reflected by the relatively narrow CIs (Table (Table55). 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. 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. Limitations of this review relate to the search strategy used. That is usually the journal article where the information was first stated. government site. These authors demonstrated significantly larger (better) positive likelihood ratios and significantly smaller (better) negative likelihood ratios than the McMurray's. Changing the threshold to increase sensitivity decreases specificity and vice versa. MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 The Valgus Test of the knee is performed with the patient lies in the supine position. [1] It is one of 4 critical ligaments involved in stabilizing the knee joint. The therapist applies a valgus stress at the knee while the ankle is stabilized in slight lateral rotation either with the hand or with the leg held between the examiners arm and trunk. . 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. followers, 712k Describes clinical information available to raters, Describes statistical methods for comparing diagnostic accuracy and expressing uncertainty, Describes methods for calculating test reproducibility; if done, Reports when study was done with start and end dates for recruitment, Reports clinical and demographic characteristics of subjects, Reports how many subjects satisfying inclusion criteria did not undergo the tests; describes why these subjects were not tested, Reports time interval between researched and reference test and any treatment provided in between tests, Reports disease severity in subjects with target condition and other diagnoses in subjects without target condition, Reports cross-tabulation of researched and reference test, Reports adverse effects from researched and reference test, Reports estimates of diagnostic accuracy and measures of statistical uncertainty, Reports how indeterminate test results, missing responses, and outliers of researched test were handled, Reports estimates of variability between raters, centers, or subject subgroups; if done, Reports estimates of test reproducibility; if done, Discusses clinical applicability of study findings. An example of this would be as follows: If the McMurray's test had a LR+ of 9.2 for a particular study, a positive McMurray's test is 9.2 times more likely to occur in patients with a meniscal tear than in those without one29. 2nd ed. A) AND B): The McMurray's test: Figure 1a) the tibia rotated on the femur into full internal rotation and Figure 1b) the tibia rotated on the femur into full external rotation. Orthopedic Physical Assessment: 5 th Edition. St. Louis, MO: Saunders Elsevier;2008. Results: Purpose: Knee injuries. Palpation for joint line tenderness, the Apley's Grind test, and the McMurray's test are commonly used in physical therapy practice1. Sensitivity & Specificity Sensitivity: 66 % Specificity: 60 % A study on 21 patients referred with chronic medial collateral ligament injuries, the Valgus stress test at 30, 60, 70, or 90 degrees of elbow flexion was performed (The Reference Standard was Surgical visualization ). Similarly, Corea et al4 included consecutive patients who were clinically diagnosed as having torn menisci based on a number of signs and symptoms including locking, a positive McMurray's test, painful clicks, and giving way. NjZjMWViMWE5MzNlMDFhOTA3YzAwYzUzODYzZmQyZGI2ODk1ZmJlOGM4YzZh The accurate diagnosis of meniscal pathology on the basis of the findings of such tests is often difficult. One of the search terms used was McMurray$ test$. MDYzNWEzNGQxNDFiMmU0MDBmMmJkZTU4YzNiNzE1MWYxNWM3ZGU1NzFkM2Zm 1st ed. OGNkMmFkZGY0YjIxNzkxN2RkOTg3YzgzMTdiYjY1OGMxMzA2NThmZjIxNGNi 2018 Aug;46(10):2355-2365. doi: 10.1177/0363546518784301. The review suggests that modifications of the interpretation of a positive test to include reproduction of pain either as well as or on its own may enhance the validity of the test. Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality[7] A recent meta-analysis reports sensitivity and specificity to be 70% and 71%. . Federal government websites often end in .gov or .mil. Reid MC, Lachs MS, Feinstein AR. These authors demonstrated marginally better LR+ but most interestingly, reported that their modified test (the KKU test) was 100% sensitive for lateral meniscal tears indicating that the test can be used for excluding a condition when it is negative. 2017 Mar;101(Suppl 1):23-35. doi: 10.1007/s12306-017-0460-5. eCollection 2018 May. [1] The therapist applies a valgus stress at the knee while the ankle is stabilized in slight lateral rotation either with the hand or with the leg held between the examiner's arm and trunk. Sae-Jung et al24 considered pain or a clicking sound to be a positive test. 8600 Rockville Pike [8], Mechanism of injury: (for more information, see the page on LCL injuries)[4], Patient position: Legs crossed with ankle resting on opposite knee (90 knee flexion, hip abduction and external rotation). 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. 8600 Rockville Pike OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi 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). [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. [1] Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1. Specificity is the proportion of patients without the condition who have a negative test result and indicates the ability to use a test to recognize when the condition is absent11. This is a key test to perform when assessing for posterolateral instability of the knee. YmQ4NDJhMzZkOWUyMDUwNzAxN2M3ZjVhOGYyYmU0ZDVkYWUxNWM0ZGFhMTFi Irwig L, Tosteson AN, Gatsonis C, et al. However, only Kurosaka et al6 and Evans et al23 made it clear that the examiners were not given any details about the subject's history so that they would not be influenced by this information. Akseki et al3 compared the McMurray's test with a weight-bearing version of the McMurray's test that incorporated axial compression and varus/valgus stress, with the patient squatting down in internal and then external rotation (Ege's test). [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. Table Table55 shows the LR+ and LR for the 11 studies included within this review with 95% CIs. Karachalios et al21 incorrectly added valgus or varus stress as a component of the McMurray's. Statistical evaluation of McMurray's test in the clinical diagnosis of meniscus injuries. MGQ5MzQyZWI5MjJjMjUxYjFhM2E1ZjQ5NTgzMzdmNTY4NmYwZWM1ZWQ3YTU3 ZDFjNGQ5ZTg3MjdkZDAxOTE5MTYxNDQ3NmIzYzNhZjE4ZjAwNDc4M2NiMzEz 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. Yedlinsky, N.T. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A wide variety of clinical tests are used to diagnose meniscal pathology within the knee joint. This study evaluated not only the McMurray's test but also a new test (Ege's test) for meniscal pathology that is performed in a weight-bearing position. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. Specificity: not reported. Thus, to avoid selection bias, it is important that a study include consecutive patients with pathologies that could be commonly confused with a meniscal tear and should not include patients without symptoms. 5, pp. 2019 Jan 21;8(2):e141-e145. ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz The therapist applies a varus stress at the knee while the ankle is stabilized. How to appraise a diagnostic test. The agreed quality for each paper is included in Table Table33. NCI CPTC Antibody Characterization Program. Ciba M, Winkelmeyer EM, Schock J, Westfechtel S, Nolte T, Knobe M, Prescher A, Kuhl C, Truhn D, Nebelung S. Sci Rep. 2022 Jul 13;12(1):11858. doi: 10.1038/s41598-022-15787-2. In testing the accuracy of a clinical test like the McMurray's test, ideally the study participants should consist of individuals who would be likely to undergo the test in clinical practice and who have a reasonable chance of having the condition16. MTk2NGZhNDE4OTk1NmViZWEyZWM3NzcwNDY0NzA4Y2VmMzBjNjI3MjUwNzdj [1]. Pg 791. This trade-off between sensitivity and specificity makes it important that they be considered jointly27. IR of the tibia + Varus stress = lateral meniscus, ER of the tibia + Valgus stress = medial meniscus. Four studies demonstrated that a positive test alters the probability to only a small, rarely important degree5,6,25, suggesting uncertainty that a positive test will indicate meniscal pathology (Table (Table5).5). The reported incidence of ACL sprains and tears in the knee injuries. The Management of Sofi Tissue Knee Injuries: Internal Derangements. Based on the STARD scoring of each paper, it is possible to make a qualitative assessment about the methodological quality. Malanga GA, Andrus S, Nadler SF, McLean J. 2008 Saunders. Both imaging modalities are recommended to diagnose both acute and chronic FCL injuries. Level II, case-control study. Biomechanics of musculoskeletal injury. 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. Accessibility 4th Edition. 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. Sackett D, Richardson S, Rosenberg W, Haynes RB. Consecutive patients suspected of having meniscal tears presenting for arthroscopy: acute and chronic (ligament injuries excluded). Solomon DH, Simel DL, Bates DW, Katz JN, Schafter JL. The goal of the study was to evaluate 3 common manual tests (Buell, Dananberg, and Jack tests) for assessing first metatarsophalangeal joint (MPJ) mobility and determining the normal values needed to detect FHL . McMurrays test revisited: Evaluation of various methods of performing McMurrays test, Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue SUPP_II, 320. https://www.physio-pedia.com/index.php?title=McMurrays_Test&oldid=322145. The Journal of Manual & Manipulative Therapy. Varus stress test video provided by Clinically Relevant, Additional tests for detecting LCL injury with other knee ligaments:[6], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Bearing these findings in mind, the following recommendations can be made for the clinician: This review has demonstrated that the intertester reliability and sensitivity of the McMurray's test is relatively low; however, it has also highlighted that it can be a relatively specific test, especially with respect to the lateral meniscus. The test is performed at 0 and 20-30, so the knee joint is in the closed packed position. Excluding any with past history of trauma and any with associated fractures, serious arthrosis, previous history of knee surgery or discoid meniscus identified arthroscopically. The findings of studies testing the validity of the McMurray's test have varied widely, mostly due to variations in the size and type of the study population as well as differences in description and application of the test3. When evaluating any diagnostic test, commonly used parameters are its sensitivity and specificity. If a study evaluates a test in a very specific group of patients, its findings can only be applied to that same type of cohort. Patients diagnosed with meniscal lesions (based on symptoms including pain, recurrent edema, giving way, joint clicks, or block to movement) having arthroscopic surgery. Grade II: The joint space opens 3-5 mm more than the contralateral side in 20 degrees of knee flexion and less than 2 mm more than the normal knee in full extension. There . Diagnosis of acute knee ligament injuries: The value of stress radiography compared with clinical examination, stability, under anesthesia and arthroscopic or operative findings. Also described a weight-bearing modification of McMurray's (Thessaly test), n/m for McMurray's, but joint line discomfort and possibly a sensation of locking or catching for Thessaly test. [7] It is commonly associated with other knee ligament injuries, thus LCL tear can be easily overlooked as a result of that. Rose NE, Gold SM. New York: Appleton-Century-Crofts, 1976. Grade III: The joint space opens 5 . The proportion of people who test negative and who do not have the disease or dysfunction. Noble J, Erat K. In defence of the meniscus: A prospective study of 200 menisectomy patients. National Library of Medicine ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh Each test is repeated with the knee in full extension. The reliability of this test in extension is 68% and in 30 flexion only 56%. $ is the truncation character. [4] The popliteus tendon is deep to the LCL, seperating it from the lateral meniscus. 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. Painful conditions of the knee, inPain Management Vol 1.,2007. The same maneuvers are performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the menisci. 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. A recent study by Akseki et al3 reported high combined sensitivity and specificity figures (63% and 83%, respectively) and relatively narrow confidence intervals (Table (Table5).5). Does the patient have a torn meniscus of ligament of the knee? There are several different reported methods of performing McMurrays Test, Reiders method may be the most accurate[9], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. McMurray's test is used to determine the presence of a meniscal tear within the knee. Consecutive patients scheduled for menisectomy; acute and chronic. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Other studies3,5,19 commented that greater clinical experience may affect the results of the test but they did not provide any statistical evidence to support this assertion. At the proximal level this ligament is closely related to the joint capsule, without having direct contact, as it is separated by fat pad, The insertion is augmented by the iliotibial band. 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). Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. This lack of consensus in the literature highlights the risk that the criteria indicating a positive test can influence the test outcome, irrespective of whether the test was performed in the same manner on the same patient. Although sensitivity and specificity values provide useful information, they work against the direction of clinical testing11. The incidence of LCL injuries are relatively low (6%) when compared to other knee injuries. However, these authors stated that they determined these findings in a study of 20 subjects prior to the main study and they did not provide any details of how this pilot study was performed or analyzed. Clipboard, Search History, and several other advanced features are temporarily unavailable. Manoeuvres assessing the posterolateral structures include the varus stress test, dial test, the posterolateral drawer, the external rotation recurvatum test, heel height test and the reverse pivot shift. A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. official website and that any information you provide is encrypted Symptoms related to an intra-articular knee pathology. Future research should concentrate on building a strong methodological base incorporating large samples of consecutive patients with commonly confused pathologies. Although six studies used multiple testers, these did not provide statistics for reliability6,1923. Only one study by Harilainen et al. M2ZmZDZjMzRlNTA5MjMyYzZkMGVlMDJkNzM3ODllMjM3ODFmYWJhZjAwYzZh No valgus or varus stress is applied. The best statistics for summarizing usefulness of a diagnostic test appear to be likelihood ratios (LR)17. Corea JR, Moussa M, Al Othman A. McMurray's test tested. Study with Quizlet and memorize flashcards containing terms like Ballottement, Valgus Stress Test, Varus Stress Test and more. [5], The LCL stabilizes the lateral side of the knee joint, mainly in varus stress and posterolateral rotation of the tibia relative to the femur. Schulzer M. Diagnostic tests: A statistical review. Based on MRI, overall specificity was 68%. Simmel DL, Samsa GP, Matchar DB. Sensitivity: 25% . Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. -----BEGIN REPORT----- Intertester reliability of clinical judgements of medial knee ligament integrity. Sensitivity: the ability of a test to correctly identify patients with a disease. MDUwOTJiNWVjMDExNzg5OTRkYzIwNjRlYzdhZmM2MzUyYjUwY2IxYTkzMTRk In most cases Physiopedia articles are a secondary source and so should not be used as references. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. eyJtZXNzYWdlIjoiMDAzMWIwNTU1ZDk0ZjIzMGU1NDkwYzhmOWYxZTk0YWI3 Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). The external validity of a study is largely dependent on the study population. The acute tears frequently result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee.[3]. Reverse Pivot Shift Sign of Jakob, Hassler, and Stubli. 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. Bhandari M, Guyatt GH. YmRhYTcyZWFhNTQ5OTM0YWYwODRjZDU1OWU3ZjBjNmMyMjA4NTcxZTRmMDYw Varus stress testing was performed in 20 of flexion, and testing in extension was not done. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. It seems logical that those studies that include both pain and a click should have higher diagnostic value as compared to studies that just use one sign or the other. Address all correspondence and requests for reprints to: Wayne Hing. . True positive: the person has the disease and the test is positive. These comments are also supported by the findings of a recent meta-analysis carried out by Hegedus et al7 and Meserve et al8. 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. 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. The wide range of positive likelihood ratios (0.828.86) make it difficult to draw any conclusions about the actual magnitude of this ratio. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). MDU1NWE1Nzc5OGVjNTczOGU2OWUyMWYxYmY3Njk5ZTdlMDEwZTQ3MTY0Zjdm Careers, Unable to load your collection due to an error. Those that do not include consecutive patients and those that exclude different pathologies may have biased results. PMC eCollection 2019 Feb. In order to make the retrieval of articles as comprehensive as possible, a generic search strategy was employed using Medline, CINAhL, and AMED databases through OVID, SPORTDiscus database through EBSCO, and SCOPUS, from 1980 to May 2008. Sensitivity is the probability of a positive test result in someone with the pathology, whereas specificity is the probability of a negative test result in someone without the pathology.6Traditionally, tests which have high sensitivity values are able to correctly identify individuals with the pathology; thus, if the examiner obtains a negative While it is difficult to compare results across studies due to the differences in the tests being used, the results of this review appear to show that the modified tests have higher diagnostic value than the McMurray's test. This was a purposeful strategy designed to enhance their ability to determine the true sensitivity and specificity of the McMurray's test in a population that reflects the symptomatic knee cohort that presents clinically. Specificity: 100% Valgus Stress Test: Sensitivity: 91% Specificity: 17% Varus Stress Test: Sensitivity: 25-77% Specificity: 98-99% Quadriceps Active Test: Sensitivity: 54-99% Specificity: 97-100% Posterior Sag Test: Inconclusive.
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