Gursoy S, Perry AK, Dandu N, Singh H, Vadhera AS, Yanke A, LaPrade RF, Chahla J. Orthop J Sports Med. 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. The sensitivity and specificity of the McMurray's test reported in the studies identified in this review vary widely (Table (Table5).5). ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz The physiotherapist stabilize the knee with one hand, while the other hand adducts the ankle.[10]. [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. doi: 10.1016/j.eats.2018.10.007. National Library of Medicine The lower the LR, the more certain you can be that a negative test indicates the person does not have the disorder11 (Table (Table6).6). 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). Review of meniscal injury and associated sports. ODFlNzFkZTQ2MDZmOTVkM2Q1MjEzNzY5YTlmZTU2MTRmYWFkYzY2ZmRmNzlj Be aware of the validity issues surrounding this test. 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. Sensitivity figures vary from 16%88%, while specificity figures vary from 20%98% (Table (Table5).5). Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. eyJtZXNzYWdlIjoiMDAzMWIwNTU1ZDk0ZjIzMGU1NDkwYzhmOWYxZTk0YWI3 Increased Accuracy of Varus Stress Radiographs Versus Magnetic Resonance Imaging in Diagnosing Fibular Collateral Ligament Grade III Tears. A total of 232 patients were included: 98 patients in the FCL tear group (mean age: 33.6 12.2 years) and 134 patients in the control group (mean age: 44.0 17.2 years). Statistical evaluation of McMurray's test in the clinical diagnosis of meniscus injuries. They rated the sensitivity at 25% and could not report any specificity percentage. DOI https://doi.org/10.1016/C2009-1-59662-1. Human Kinetics, 2008. Clinical Rehabilitation, 22(2), 143-61. Epub 2018 Jul 17. Comparison of likelihood ratio's for McMurray's test with modified tests. Fritz JM, Wainner RS. Evaluation of Knee Instability in Acute Ligamentous Injuries. 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. -----BEGIN REPORT----- 2nd ed. Diagnosis of acute knee ligament injuries: The value of stress radiography compared with clinical examination, stability, under anesthesia and arthroscopic or operative findings. Both arthroscopy and MRI have been used as a gold standard measure for detection of meniscal injuries in knees. Although blinding was not mentioned in respect to the other studies, the majority required the clinical examination to be performed prior to the diagnostic arthroscopy, suggesting that the examiner would indeed be blinded to the results of the diagnostic test. The best statistics for summarizing usefulness of a diagnostic test appear to be likelihood ratios (LR)17. Conclusions: The agreed quality for each paper is included in Table Table33. MDUwOTJiNWVjMDExNzg5OTRkYzIwNjRlYzdhZmM2MzUyYjUwY2IxYTkzMTRk Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Studies investigating the validity of diagnostic tests such as the McMurray's compare the findings of that test with a reference (gold) standard that has demonstrated validity11. More recent research has shown that modifications to the original McMurray's test may have better validity and diagnostic accuracy than the original McMurray's test3,58. In: Campbell's Operative Orthopaedics. In total, 11 studies have been included in this critical review. Copyright 2018 Arthroscopy Association of North America. Powell JW, Huijbregts PA. Concurrent criterion-related validity of acromioclavicular joint physical examination tests: A systematic review. The Management of Sofi Tissue Knee Injuries: Internal Derangements. Corea JR, Moussa M, Al Othman A. McMurray's test tested. The results support the use of both varus stress radiographs and MRI in diagnosing FCL injuries, because MRI is more sensitive in diagnosing an acute FCL tear, and varus stress radiographs are more sensitive in diagnosing a chronic FCL tear. 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. government site. All abstracts for 44 articles from Medline, 19 articles from CINAhL, 5 articles from AMED, 18 articles from SPORTSDiscus, 548 articles from SCOPUS, and 6 articles from the hand search were reviewed by the authors (Figure (Figure2).2). Authors of 9 studies examined the Lachman test and reported sensitivity values ranging from 0.63-0.93 and specificity values ranging from 0.55-0.99. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Epub 2018 Jul 27. Bhandari M, Guyatt GH. 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. The reliability of this test in extension is 68% and in 30 flexion only 56%. [1]. Use of methodological standards in diagnostic test research: Getting better but still not good. 269-273). Review bias may result when the findings of the reference standard test are known by the clinicians performing the diagnostic test. 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. The test is fairly solid. 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. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. 8600 Rockville Pike In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. Elsevier Health Sciences, 2014. Bossuyt PM, Reitsma JB, Bruns DE, et al. There is conflicting evidence with respect to the effect of the presence of an associated anterior cruciate ligament (ACL) deficiency. There is conflicting evidence in the literature over the accuracy of MRI. Arthroscopy. 24 General examination included carrying angle (normal, valgus,. 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. Download scientific diagram | AP and lateral radiographic images of a SE-4 fracture consisting of a spiral or oblique fracture laterally with a combination of an avulsion fracture medially. [2]Meniscal tears may occur in acute knee injuries in younger patients or as part of a degenerative process in older individuals. Varus Stress Test - Physical Therapy Haven However, they only included patients who had had symptoms for at least one year, making extrapolation of their findings to the acute population challenging. Varus Test Of The Knee 2023 | OrthoFixar Specificity: not reported. 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. The importance of the valgus stress test in the diagnosis of - PubMed St. Louis, MO: Saunders Elsevier;2008. These authors suggested that this increase in sensitivity and specificity compared to previous studies was due to their broader definition of a positive test, i.e., reproduction of a click or pain3; however, this does not explain the similar findings of Corea et al4 in which only a click was indicative of a positive test. This trade-off between sensitivity and specificity makes it important that they be considered jointly27. Clipboard, Search History, and several other advanced features are temporarily unavailable. Muellner T, Weinstabl R, Schabus R, Vecsei V, Kainberger F. The diagnosis of meniscal tears in athletes: A comparison of clinical and magnetic resonance imaging investigations. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Accessibility The test has therefore often been reported to be of limited value in current clinical practice. Applied Sciences | Free Full-Text | Comparison of Diagnostic - MDPI [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. A prospective study comparing the accuracy of the clinical diagnosis of meniscal tears with magnetic resonance imaging and its effect on clinical outcome. Kurosaka et al6 took the modification of the Medial-Lateral Grind test further by comparing the McMurray's test to a pivot shift test that not only had a component of varus/valgus stress but also included a component of axial loading. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). TP=true positive, FP=false positive, FN=false negative, TN=true negative. Anterior cruciate ligament reconstruction: MR imaging findings. Valgus Stress Test | Medial Collateral Ligament (MCL) Injury - Physiotutors HHS Vulnerability Disclosure, Help Partial Controlled Early Postoperative Weightbearing Versus Nonweightbearing After Reconstruction of the Fibular (Lateral) Collateral Ligament: A Randomized Controlled Trial and Equivalence Analysis. Level II, case-control study. Measures of efficacy include accuracy, sensitivity, and specificity. 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. Zappia M, Capasso R, Berritto D, Maggialetti N, Varelli C, D'Agosto G, Martino MT, Carbone M, Brunese L. Musculoskelet Surg. The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi The therapist applies a varus stress at the knee while the ankle is stabilized. LaPrade RF, DePhillipo NN, Cram TR, Cinque ME, Kennedy MI, Dornan GJ, O'Brien LT. Am J Sports Med. Fowler PJ, Lubliner JA. 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. 2001;177(2):409413. 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. With one hand fixate the femur. In general, sensitivity figures are much lower than specificity and the CI limits are wider. J Sport Rehabil. (PDF) Physical examination of the elbow, what is the evidence? A Boeree NR, Ackroyd CE. Relatively narrow confidence intervals also attest to the reliability of these two studies3,4 (Table (Table55). 13th ed. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). We hypothesized that valgus arthritic knees would respond better to conservative treatment than varus . 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. DOI https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2. Acute injuries excluded. [2] Harilainen A et al. 2008 Saunders. The .gov means its official. The predictive value of Thve clinical signs in the evaluation of meniscal pathology. 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. Fibular collateral ligament and the posterolateral corner. Varus Test | Special Tests As the knee goes into flexion, the LCL loses its significance and influence as a varus-stabilizing structure. YWU3NTg0YTg5NzcxMzE4M2I5NjZiYzgxNzlkYjQyNmRjYjE1OWNjZjJmNzVh OGNkMmFkZGY0YjIxNzkxN2RkOTg3YzgzMTdiYjY1OGMxMzA2NThmZjIxNGNi MeSH The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. Table Table55 shows the LR+ and LR for the 11 studies included within this review with 95% CIs. The confidence interval (CI) attests to the precision of this estimate11. Miller RH, Azar FM. A consensus method was used to discuss and resolve discrepancies between the markings of each paper between the three reviewers. Moore KL, Dalley AF, Agur AMR. 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. 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. 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. YjQ3NDViZGE1YWVjODEwNTIzYzIyMmY1YjViMDhhNGI3Y2YyNTI4NmMwMjli Orthopedic Physical Assessment: 5 th Edition. Blinding of the clinicians from the results of the diagnostic test was either not mentioned or not performed in all of the studies in this review except for the study by Karachalios et al21. Based on MRI, overall specificity was 68%. The studies that compared the diagnostic accuracy of the McMurray's test with that of modified versions of the test showed enhanced diagnostic accuracy for the modified tests. Knee injuries. Consecutive patients with knee pain of at least one year's duration that warranted arthroscopic investigation. Varus Stress Test - The Student Physical Therapist The reported incidence of ACL sprains and tears in the knee injuries. Higher specificity figures denote that in general when the McMurray's test is positive, it is fairly reliable for ruling in meniscal pathology. The other hand provides a varus stress to the ankle. The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is unlocked.1. Address all correspondence and requests for reprints to: Wayne Hing. . When refering to evidence in academic writing, you should always try to reference the primary (original) source. government site. Limiting the search to English language articles only may also have led to an omission of other relevant studies. McMurray. The test is fairly solid. Patient in supine. The STARD checklist contains 25 items that help to make a judgment about potential bias in the study and appraisal of the applicability of the findings. Given the results of the multivariate regression in Question 1, write the regression equation associated with this study. Consequently, it is likely that the accuracy of meniscal testing demonstrated by this study is artificially high compared to studies with a wider inclusion criteria. 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). Studies were included for analysis if they compared the McMurray's test with a gold standard of knee arthroscopy or magnetic resonance imaging (MRI). Physical examination consisted of general elbow examination and specific examination of the distal biceps based on literature. The review also highlights the idea that modified versions of the test seem to be more valid than the original version. 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. Arthrosc Tech. followers, 277k The acute tears frequently result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee.[3]. AP and lateral radiographic images of a SE-4 fracture - ResearchGate YzM5MWNkYzMyMjQ0ZmU4MDdjZjg2NzYxZjhlMGI2N2RmMGI3ODExOWFmMDdl Six of the studies within this review included consecutive patients (Table (Table4).4). 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. 2018 May 2;6(5):2325967118770170. doi: 10.1177/2325967118770170. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. The Valgus Test of the knee is performed with the patient lies in the supine position. This site needs JavaScript to work properly. 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). Before 5, pp. Three studies used only one tester4,5,25, and two studies did not mention how many examiners were used3,24. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. The differences in study populations are likely to have contributed to the wide variability of results across studies. NWI4Njg2Y2FiM2QzZGFjNjA2MjRhYTcxMTY2NmVkZmYzNTMwZDdiNTk4YTcy Oberlander MA, Shalvoy RM, Hughston JC. An LR of 1 indicates that the test result does nothing to change the likelihood that the patient either does or does not have the condition, whereas the higher the LR+, the more certain you can be that a positive test indicates the person has the disorder. Changing the threshold to increase sensitivity decreases specificity and vice versa. 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. Original description. NzM3NDQ2NDMzYThiNjlhNjA0M2M3MzVlMWFhYmE5ZDI3ZTI0YTIyZGIyNWM4 Purpose: The Varus Stress Test is used to assess the integrity of the LCL or lateral collateral ligament of the knee. During the maneuver, the joint line is palpated both medially and laterally. So, little is known about the validity of this test. Inclusion in an NLM database does not imply endorsement of, or agreement with, I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). This an indication of a LCL tear. any of these symptoms can indicate a compromised medial or lateral meniscus. Consecutive patients. 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. Patients diagnosed with meniscal lesions (based on symptoms including pain, recurrent edema, giving way, joint clicks, or block to movement) having arthroscopic surgery. 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. Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. ZmFjMDhjZmYyOWRiNWU2YjhhMWNhYjFiNTU5YTI5ODM3MTY1ODYwYzc2NmFi 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. This means that tests rarely have both high sensitivity and specificity. $ is the truncation character. National Library of Medicine Consecutive patients suspected of having meniscal tears presenting for arthroscopy: acute and chronic (ligament injuries excluded). [1] Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1. Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. Take the leg and bring it in 30 Flexion (MLPP) and use a cushion or edge of the bed so the patient can relax. How to appraise a diagnostic test. A prospective evaluation of a test for lateral meniscal tears. Anderson AF, Lipscomb AB. 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. Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. 2006;20:8594. Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. Sensitivity can be defined as the proportion of patients with the condition who have a positive test result and represents the ability of the test to recognize the condition when present11. The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur. MTk2NGZhNDE4OTk1NmViZWEyZWM3NzcwNDY0NzA4Y2VmMzBjNjI3MjUwNzdj Sensitivity: the ability of a test to correctly identify patients with a disease. In extension, the posterior capsule and cruciate ligaments act as secondary restraints for varus stress. 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. MDU1NWE1Nzc5OGVjNTczOGU2OWUyMWYxYmY3Njk5ZTdlMDEwZTQ3MTY0Zjdm The examiner should passively bend the affected leg to about 30 degrees of flexion. 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. Sensitivity, specificity, and likelihood ratios (LR) of the McMurray's test with confidence intervals (CI). 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. Moreover, the ACL stabilizes the knee's rotation under varus or valgus stress. 1173185. The site is secure. -----END REPORT-----. Careers, Unable to load your collection due to an error. . 3rd edition. So, little is known about the validity of this test. A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). There are also discrepancies in the studies as to what constitutes a positive McMurray's test. official website and that any information you provide is encrypted Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. 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. 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. Kane PW, Cinque ME, Moatshe G, Chahla J, DePhillipo NN, Provencher MT, LaPrade RF. Consecutive patients awaiting elective arthroscopy for suspected meniscal or other conditions based on history and physical examination. Acute patients (< 6 weeks) excluded. Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy.