Clinical reliability of 6 meniscal tests: a diagnostic accuracy study of 255 patients
DOI:
https://doi.org/10.2340/17453674.2025.43906Keywords:
Arthroscopy, Clinical Test, Diagnosis, Knee, Meniscus, MRIAbstract
Background and purpose — We aimed to evaluate the diagnostic accuracy of 6 clinical tests for meniscal tears comparing them with MRI and arthroscopy in a cross-sectional study.
Methods: 255 patients (20–45 years) with knee trauma were examined by 2 orthopedic surgeons blinded to the patient’s history, MRI result, and the first clinical examination. The clinical tests (Joint Line Tenderness, McMurray, Apley, Thessaly, Ege, and Hyper-flexion) were conducted between 5 and 7 days post-injury (T1) and 4–5 weeks post-injury (T2). Diagnostic accuracy was determined based on MRI and arthroscopic findings, evaluating sensitivity, specificity, and predictive values.
Results: Arthroscopy confirmed 188 meniscal tears. The McMurray demonstrated the most balanced performance, with sensitivity of 91% at T1 to 80% at T2 with specificity increase from 55% to 79% showing the highest positive predictive value (PPV) of 92% at T2. Combining McMurray and Apley yielded the best accuracy minimizing false positive. McMurray and Hyper-flexion were more sensitive to medial chondropathy; Thessaly, Ege, and Hyper-flexion were more influenced by anterior knee pain.
Conclusion: No single clinical test was sufficiently reliable for independent diagnosis, reinforcing the need for MRI confirmation and further refinement of clinical evaluation strategies.
Downloads
References
Greis P E, Bardana D D, Holmstrom M C, Burks R T. Meniscal injury: I. Basic science and evaluation. J Am Acad Orthop Surg 2002; 10(168-176): 12041938. DOI: https://doi.org/10.5435/00124635-200205000-00003
Logerstedt D S, Snyder-Mackler L, Ritter R C, Axe M J, Godges J. Knee pain and mobility impairments: meniscal and articular cartilage lesions: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2010; 40(6): A1-A35. doi: 10.2519/jospt.2010.0304. DOI: https://doi.org/10.2519/jospt.2010.0304
Akseki D, Özcan Ö, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray’s test and joint line tenderness. Arthroscopy 2004; 20(9): 15525928. DOI: https://doi.org/10.1016/S0749-8063(04)00861-8
Hegedus E J, Cook C, Hasselblad V, Goode A, Mccrory D C. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. J Orthop Sports Phys Ther 2007; 37(9): 541-50. doi: 10.2519/jospt.2007.2560. DOI: https://doi.org/10.2519/jospt.2007.2560
Smith B E, Thacker D, Crewesmith A, Hall M. Special tests for assessing meniscal tears within the knee: a systematic review and meta-analysis. Evid Based Med 2015; 20(3): 88-97. doi: 10.1136/ebmed-2014-110160. DOI: https://doi.org/10.1136/ebmed-2014-110160
Hing W, White S, Reid D, Marshall R. Validity of the McMurray’s test and modified versions of the test: a systematic literature review. J Man Manip Ther 2009; 17(1): 22-35. doi: 10.1179/106698109790818250 DOI: https://doi.org/10.1179/106698109790818250
Mahnik A, Mahnik S, Hrabac P, Bojanic I. Using a combination of three clinical tests for detecting meniscal tears increases the accuracy of the clinical examination. J Sports Med Phys Fitness. Published online 2024. doi: 10.23736/S0022-4707.24.15584-3 DOI: https://doi.org/10.23736/S0022-4707.24.15584-3
Hossain S, Sundar M S. Negative knee arthroscopy: is it really negative? Arthroscopy 2001; 17(6): 11447550. DOI: https://doi.org/10.1053/jars.2001.24703
Weinstabl R, Muellner T, Vecsei V, Kainberger F, Kramer M. Economic considerations for the diagnosis and therapy of meniscal lesions: can magnetic resonance imaging help reduce the expense? World J Surg 1997; 21(363-368): 9143565. DOI: https://doi.org/10.1007/PL00012254
Bansal P, Deehan D J, Gregory R J H. Diagnosing the acutely locked knee. Injury 2002; 33(6): 495-8. doi: 10.1016/S0020-1383(02)00081-5. DOI: https://doi.org/10.1016/S0020-1383(02)00081-5
Canale S T, Beaty J. Campbell operative orthopaedics. Philadelphia: Mosby/Elsevier. Published online 2003.
McMurray T P. The semilunar cartilages. Br J Surg 1949; 29: 407-14. DOI: https://doi.org/10.1002/bjs.18002911612
Apley A G. Diagnosis of meniscus injuries. Some new clinical methods. J Bone Joint Surg 1947; 29A: 79-84. PMID: 20284687.
Konan S, Rayan F, Haddad F S. Do physical diagnostic tests accurately detect meniscal tears? Knee Surg Sports Traumatol Arthrosc 2009; 17(806-811): 19399477. DOI: https://doi.org/10.1007/s00167-009-0803-3
Eren O T. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears. Arthroscopy 2003; 19(8): 14551547. DOI: https://doi.org/10.1016/S0749-8063(03)00736-9
Rinonapoli G, Carraro A, Delcogliano A. The clinical diagnosis of meniscal tear is not easy: reliability of two clinical meniscal tests and magnetic resonance imaging. Int J Immunopathol Pharmacol 2011; 24(1 Suppl 2): 39-44. doi: 10.1177/03946320110241S208. DOI: https://doi.org/10.1177/03946320110241S208
Galli M, Ciriello V, Menghi A, Aulisa A G, Rabini A, Marzetti E. Joint line tenderness and McMurray tests for the detection of meniscal lesions: what is their real diagnostic value? Arch Phys Med Rehabil. Published online 2012. doi: 10.1016/j.apmr.2012.1.008. DOI: https://doi.org/10.1016/j.apmr.2012.11.008
Krakowski P, Nogalski A, Jurkiewicz A, Karpiński R, Maciejewski R, Jonak J. Comparison of diagnostic accuracy of physical examination and MRI in the most common knee injuries. Appl Sci 2019; 9(19): 4102. doi: 10.3390/app9194102. DOI: https://doi.org/10.3390/app9194102
Abdon P, Lindstrand A, Thorngren K G. Statistical evaluation of the diagnostic criteria for meniscal tears. Int Orthop 1990; 14(341-345): 2076915. DOI: https://doi.org/10.1007/BF00182641
Farina E M, Lowenstein N A, Chang Y, Arant K R, Katz J N, Matzkin E G. Meniscal and Mechanical symptoms are associated with cartilage damage, not meniscal pathology. J Bone Joint Surg Am 2021; 103(5): 381-8. doi: 10.2106/JBJS.20.01193. DOI: https://doi.org/10.2106/JBJS.20.01193
McHugh C G, Matzkin E G, Katz J N. Mechanical symptoms and meniscal tear: a reappraisal. Osteoarthritis Cartilage 2022; 30(2): 178-83. doi: 10.1016/j.joca.2021.09.009. DOI: https://doi.org/10.1016/j.joca.2021.09.009
Bergkvist D, Dahlberg L E, Neuman P, Englund M. Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find?: sn evaluation from southern Sweden. Acta Orthop 2016; 87(1): 12-16. doi: 10.3109/17453674.2015.1055179. DOI: https://doi.org/10.3109/17453674.2015.1055179
Munshi M, Davidson M, MacDonald P B, Froese W, Sutherland K. The efficacy of magnetic resonance imaging in acute knee injuries. Clin J Sport Med 2000; 10(1): 34-9. doi: 10.1097/00042752-200001000-00007. DOI: https://doi.org/10.1097/00042752-200001000-00007
Amin N, McIntyre L, Carter T, Xerogeanes J, Voigt J. Cost-effectiveness analysis of needle arthroscopy versus magnetic resonance imaging in the diagnosis and treatment of meniscal tears of the knee. Arthrosc J Arthrosc Relat Surg 2019; 35(2): 554-62.e13. doi: 10.1016/j.arthro.2018.09.030. DOI: https://doi.org/10.1016/j.arthro.2018.09.030
Yan R, Wang H, Yang Z, Ji Z H, Guo Y M. Predicted probability of meniscus tears: comparing history and physical examination with MRI. Swiss Med Wkly. Published online 2011. doi: 10.4414/smw.2011.13314. DOI: https://doi.org/10.4414/smw.2011.13314
Additional Files
Published
How to Cite
License
Copyright (c) 2025 Giuseppe Rinonapoli, Lorenzo Lucchetta, Giulio Ancillai, Francesco Manfreda, Paolo Ceccarini, Auro Caraffa
This work is licensed under a Creative Commons Attribution 4.0 International License.
