MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. The physiotherapist stabilize the knee with one hand, while the other hand adducts the ankle.[10]. Federal government websites often end in .gov or .mil. Solomon DH, Simel DL, Bates DW, Katz JN, Schafter JL. Generated by Wordfence at Mon, 1 May 2023 20:49:59 GMT.Your computer's time: document.write(new Date().toUTCString());. [1] Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1. ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 St. Louis, MO: Saunders Elsevier;2008. The description of a test within a study should be sufficient to enable replication of the test by practitioners and subsequent researchers. 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. Human Kinetics, 2008. NjZjMWViMWE5MzNlMDFhOTA3YzAwYzUzODYzZmQyZGI2ODk1ZmJlOGM4YzZh That is usually the journal article where the information was first stated. The confidence interval (CI) attests to the precision of this estimate11. Studies were eligible for inclusion if they assessed measures of accuracy or validity of the McMurray's test or any modification of this test against a gold standard of either arthroscopy or magnetic resonance imaging (MRI) and were written in English. Studies by Boeree and Ackroyd19, Akseki et al3, and Karachalios et al21 demonstrated small but sometimes important shifts in probability. Baker PE, Peckham AC, Pupparo F, Sanborn JC. MDYzNWEzNGQxNDFiMmU0MDBmMmJkZTU4YzNiNzE1MWYxNWM3ZGU1NzFkM2Zm 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. The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur. Studies were included for analysis if they compared the McMurray's test with a gold standard of knee arthroscopy or magnetic resonance imaging (MRI). Reverse Pivot Shift Sign of Jakob, Hassler, and Stubli. Sensitivity and specificity values fail to do this11. 1, This website is powered by SportsEngine's. 13th ed. If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. Sensitivity and specificity rely on a single threshold for classifying a test result as positive or negative. 8600 Rockville Pike Three of the studies in this review considered a positive test to be the reproduction of a palpable thud or click4,6,22 (Table (Table4).4). 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. IR of the tibia + Varus stress = lateral meniscus. J Sport Rehabil. 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. 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. Four authors stated that they used the McMurray's test but did not describe the actual testing procedure3,5,19,25. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. 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. Zappia M, Capasso R, Berritto D, Maggialetti N, Varelli C, D'Agosto G, Martino MT, Carbone M, Brunese L. Musculoskelet Surg. The site is secure. Federal government websites often end in .gov or .mil. 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. The site is secure. A consensus method was used to discuss and resolve discrepancies between the markings of each paper between the three reviewers. 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. Douglas I, McDermott Meniscal tears. In: Campbell's Operative Orthopaedics. Specificity: not reported. How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt. Fowler and Lubliner22 had a similarly broad population in that they included consecutive patients who warranted arthroscopic examination for any reason. 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. A guide to the interpretation of likelihood ratio (LR) values. This is a key test to perform when assessing for posterolateral instability of the knee. Given the results of the multivariate regression in Question 1, write the regression equation associated with this study. 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. These authors also demonstrated that the Medial-Lateral Grind test had smaller (better) LR compared to the McMurray's test although the change in probability was still only small and should be considered rarely important (Table (Table77). Although these authors mentioned that the examiners were blinded to the results of the MRI, they did not make it clear if the examiners knew that there were a similar number of normals and symptomatic subjects included in the study or if they knew which group each individual subject belonged to. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Studies looking at diagnostic accuracy, sensitivity and specificity have demonstrated varied values. Physical examination tests for assessing a torn meniscus in the knee: A systematic review with meta-analysis. Miller GK. 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. Painful conditions of the knee, inPain Management Vol 1.,2007. Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. MR imaging of meniscal cysts: incidence, location, and clinical significance. how likely a negative test result is in people who have the disease or dysfunction as compared to how likely it is in those who do not have the disease or dysfunction. Six of the studies within this review included consecutive patients (Table (Table4).4). The varying definitions of a positive McMurray's test are also likely to have contributed to the variability of the results demonstrated by the studies reviewed. A recent meta-analysis illustrates the difference in test characteristics when performed on patients under anesthesia. [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. The fibular or lateral collateral ligament (LCL) is a cord-like band and acts as the primary varus stabilizer of the knee. Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw Orthopedic Physical Assessment: 5 th Edition. 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%. 2022 Jun 6;10(6):23259671221100216. doi: 10.1177/23259671221100216. 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. Diagnostic accuracy of a new clinical test (the fiessaly Test) for early detection of meniscal tears. The proportion of people who have the disease or dysfunction who test positive. In addition, cited references of relevant articles were examined. Sackett D, Richardson S, Rosenberg W, Haynes RB. varus stress test: A test of ligament laxity, where a passive force is exerted on a joint that, in the presence of ligamentous insufficiency, would cause the lateral joint space to open, e.g., lateral collateral ligament of the knee and radial collateral ligament of the elbow. MDUwOTJiNWVjMDExNzg5OTRkYzIwNjRlYzdhZmM2MzUyYjUwY2IxYTkzMTRk 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. High sensitivity indicates that a test can be used for excluding a condition when it is negative, but it does not address the value of a positive test. When confidence intervals are not present, the CIs were incalculable due to absence of raw data. Clinical diagnosis of meniscal tears: Description of a new manipulative test. Sensitivity: 25%. Evans PJ, Bell GD, Frank CY. Valgus and Varus test of the knee can be graded by the following 1: Grade I: The joint space opening is within 2 mm of the contralateral side. [8]The test has therefore often been reported to be of limited value in current clinical practice. 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. 1985;13(1):14. Test (b): Disease Status test (b) results *Positive Negative Present 18 7 25 absent 2 73 75 total 20 80 100 Calculate the sensitivity, specificity, positive predictive values, and negative predictive values for each test. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. The external validity of a study is largely dependent on the study population. However, this provisional diagnosis was also based on other symptoms that one might consider could be associated with pathologies other than meniscal tears, e.g., pain, recurrent effusion, muscle wasting, and instability. 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. In: DeLee & Drez's Orthopaedic Sports Medicine. A wide variety of clinical tests are used to diagnose meniscal pathology within the knee joint. ODA3OTUwYWUyMzM0ODhjYWM2MzMzZDc4YTcxNWI4Njc5NDlmMTE2NjIxOTc0 Examining diagnostic tests: An evidence-based perspective. The use of the STARD tool is also a limitation. 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. Sensitivity: 25% . 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. Described a modified version (Ege's test) but no description of McMurray's. The test is fairly solid. [4] The popliteus tendon is deep to the LCL, seperating it from the lateral meniscus. ODA1ZGIwMjcwNDYzZDc3OTkwMWYwNWVkMWRlYzk1ZWExOTVhNjBiNWQ2MzUw The possibility of there being associated intra-articular pathology (such as anterior cruciate ligament rupture) confounds results, and the unknown validity, sensitivity, and specificity of the tests make it difficult for the clinician to be confident in making a definitive diagnosis3. 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). Consecutive patients scheduled for menisectomy; acute and chronic. During the maneuver, the joint line is palpated both medially and laterally. 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. The sensitivity was 87% for the medial meniscus but only 46% for the lateral meniscus13. Posterior drawer test Posterior sag test (godfrey test) Quadriceps active test Dial test Varus/valgus stress . Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. 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. 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. McMurray's test is used to determine the presence of a meniscal tear within the knee. 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). Malanga GA, Andrus S, Nadler SF, McLean J. Symptoms related to an intra-articular knee pathology. Level II, case-control study. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. Hoppenfeld S, Hutton R, Hugh T. Physical examination of the spine and extremities. Intertester reliability of clinical judgements of medial knee ligament integrity. Does the patient have a torn meniscus of ligament of the knee? An official website of the United States government. Canada. 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. Other signs that have been used to denote a positive test include the production of pain, a clunk, or a pop. 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. aAssociate Professor, health & Rehabilitation Research Centre, School of Rehabilitation and Occupation Studies, AUT University, Auckland, New Zealand, bSenior Lecturer, School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand, cHead of School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand, dSchool of Physiotherapy, Auckland University of Technology, Auckland, New Zealand. [11] Sensitivity: 25% . A recent study by Winters and Tregonning13 showed a diagnostic accuracy for MRI to be 90% for the medial meniscus and 82% for the lateral meniscus. N2MzZTc5OGFkMzAwZTZmM2Y1YWFiZTJjMjM3OGNkMmNkM2E4OTYzZWFkMjA5 The Medial-Lateral Grind test had a higher LR+ (Table (Table7)7) when compared to the McMurray's test; however, its CIs were extremely wide, bringing into question the precision of this estimate of reliability (Table (Table7).7). Comparison of likelihood ratio's for McMurray's test with modified tests. Likelihood Ratio +/-. ZDIwNGI3MGM0NDMzZmMxM2YxZDdmZWM0YmE5MDI5OWJiMmE4MmFhZTdkODE1 Consecutive patients with knee pain of at least one year's duration that warranted arthroscopic investigation. 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. Higher specificity figures denote that in general when the McMurray's test is positive, it is fairly reliable for ruling in meniscal pathology. followers, 12k Consecutive patients awaiting elective arthroscopy for suspected meniscal or other conditions based on history and physical examination. 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. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. . Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. Malanga GA, Andrus S, Nadler SF, McLean J. Merriman L, Turner W. Assessment of the Lower Limb. Because they were investigating this weight-bearing test as well, the authors excluded any patients who presented within six weeks of trauma and those unable to bear weight or unable to squat. Varus Stress Test of the Knee: Genu Varum (aka bow-leggedness, bandiness, bandy-leg, and tibia vara), is a physical deformity marked by (outward) bowing of the lower leg in relation to the thigh, giving the appearance of an archer's bow. Common terms. Eleven studies met the inclusion criteria. Both imaging modalities are recommended to diagnose both acute and chronic FCL injuries. Ann Chir Gynaecol. H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). Bethesda, MD 20894, Web Policies As a stand-alone test, it had a sensitivity of 78% and specificity of 67% the pain was used as the outcome measure and a sensitivity of 91% and specificity of 49% when laxity was the outcome measure. . 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%. Top Contributors - Rachael Lowe, Admin, Adrian Shaji, Kim Jackson, Evan Thomas, Amanda Ager, Kai A. Sigel, Wanda van Niekerk, Tony Lowe, Tyler Shultz and WikiSysop, Meniscus tears are the most common injury of the knee. YTY1NDM4NjNkYzAwMmMxNGU2MjgwMmMzODFlMTZkZmQyYjRmNTAzM2RkZWY4 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. Limits human and English. Am J Roentgenol. This site needs JavaScript to work properly. Petty NJ. There is conflicting evidence with respect to the effect of the presence of an associated anterior cruciate ligament (ACL) deficiency. 3rd edition. ZTE1ZTU0YzgxZTBhZGFlNGI5YzcyODQ4YjdhNTE5Yzc0MmMzMTI2YmQ5M2E1 eyJtZXNzYWdlIjoiMDAzMWIwNTU1ZDk0ZjIzMGU1NDkwYzhmOWYxZTk0YWI3 Only one study by Harilainen 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. They rated the sensitivity at 25% and could not report any specificity percentage. The test has therefore often been reported to be of limited value in current clinical practice. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). The test is fairly solid. [2] Harilainen A. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi These results have been supported by Karachalios et al21, who compared another weight-bearing modification (the Thessaly test) of the McMurray's with the original test. Referred from GP/A&E with suspected cruciate ligament or meniscal pathology. Simmel DL, Samsa GP, Matchar DB. 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. Kennedy MI, Akamefula R, DePhillipo NN, Logan CA, Peebles L, LaPrade RF. Selection bias may occur when study subjects are not representative of the population on whom the test is typically applied in practice and can affect the results of a study11. sharing sensitive information, make sure youre on a federal A control group was composed of patients with an MRI and intact ACL and FCL. If the CI is wide and contains values that are not clinically important, the usefulness of the measure may be questionable11. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Copyright 2018 Arthroscopy Association of North America. Biomechanics of musculoskeletal injury. 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. Kurosaka et al6 stated that diagnostic accuracy is lessened in patients with multiple pathologies, whereas Akseki et al3 found that there was no reduction in diagnostic accuracy with an associated tear of the ACL. Review bias may result when the findings of the reference standard test are known by the clinicians performing the diagnostic test. 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. Articles may have been missed based on the omission of certain search phrases or the use of a single search phrase as used in this case. HHS Vulnerability Disclosure, Help Sensitivity figures vary from 16%88%, while specificity figures vary from 20%98% (Table (Table5).5). The inclusion of patients with multiple pathologies is likely to lessen the diagnostic accuracy of a test; however, this would reflect actual clinical practice6,18. Five studies compared modified versions of the test to McMurray's3,5,6,21,24 (Table (Table33). However, in general, the CI limits are relatively narrow over all. Address all correspondence and requests for reprints to: Wayne Hing. One of the search terms used was McMurray$ test$. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. 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. (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. The reported incidence of ACL sprains and tears in the knee injuries. Pg 791. the contents by NLM or the National Institutes of Health. Akseki et al3 included consecutive patients with symptoms related to intra-articular knee pathology although how this was determined was not described. Flow diagram of literature screening process. Place the affected leg in extension and slight external rotation. Therefore, articles were assessed using the STARD (Standards for Reporting of Diagnostic Accuracy) checklist of methodological quality9, which uses established criteria for quality assessment of different research formats10. Epub 2017 Feb 14. 1173185. Sensitivity: the ability of a test to correctly identify patients with a disease. Miller RH, Azar FM. These authors considered the overall accuracy of the axially loaded pivot shift test to be higher than that of the McMurray's test (Table (Table7).7). 2008 Saunders. Consecutive patients. Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests. 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. The test is first done with the knee in full extension and then with the knee in 20-30 degrees of flexion. Prospective evaluation of the McMurray test. Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Assessment of the menisci and cruciate ligaments: An audit of clinical practice. A recent systematic review reported a diagnostic accuracy between 56 - 84% 5.A prospective cohort study of 213 patients found poor sensitivity for medial and lateral meniscus tears of 48% and 65% respectively 6.Conversely specificity for medial and lateral meniscal tears was high, 94% .
Principios Del Desarrollo Cefalocaudal Y Proximodistal,
Articles V