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. A recent literature review on composite testing of the diagnostic tests for the meniscus reported reasonable sensitivity and specificity when the findings of a number of tests are combined31. The LCL acts as a secondary stabilizer to anterior and posterior tibial translation when the cruciate ligaments are torn. Were the raters blinded to the results of the other test? 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. sharing sensitive information, make sure youre on a federal 24 General examination included carrying angle (normal, valgus,. 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. Guidelines for meta-analyses evaluating diagnostic tests. Valgus Stress Test. The other hand provides a varus stress to the ankle. Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. NCI CPTC Antibody Characterization Program. Studies were also not examined where they clearly did not meet the search criteria. When confidence intervals are not present, the CIs were incalculable due to absence of raw data. A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). 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. Consecutive patients with knee pain of at least one year's duration that warranted arthroscopic investigation. 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. Agreement regarding which articles to read in full was determined by consensus. . The acute tears frequently result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee.[3]. Positive likelihood ratios presented in the studies reviewed generally indicated small to moderate shifts in probability (0.828.86) in that a positive test will indicate true meniscal pathology although the studies with the highest methodological quality demonstrated likelihood ratios considered to indicate moderate improvements in the probability that this will be the case3,4. Eleven studies met the inclusion criteria. official website and that any information you provide is encrypted 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. Oberlander MA, Shalvoy RM, Hughston JC. [2] Harilainen A. Human Kinetics, 2008. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. [6] When the knee is extended, the LCL is stretched. 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. 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. 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. 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. The wide range of positive likelihood ratios (0.828.86) make it difficult to draw any conclusions about the actual magnitude of this ratio. Corea JR, Moussa M, Al Othman A. McMurray's test tested. Meserve BB, Cleland JA, Boucher CT. A meta-analysis examining clinical test utilities for assessing meniscal injury. The Journal of Manual & Manipulative Therapy. Fritz JM, Wainner RS. Valgus and Varus Stress Test [1] Magee DJ. N2MzZTc5OGFkMzAwZTZmM2Y1YWFiZTJjMjM3OGNkMmNkM2E4OTYzZWFkMjA5 Am J Sports Med. Am J Roentgenol. The best statistics for summarizing usefulness of a diagnostic test appear to be likelihood ratios (LR)17. Referred from GP/A&E with suspected cruciate ligament or meniscal pathology. Limitations of this review relate to the search strategy used. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. [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). 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. $ is the truncation character. 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. HHS Vulnerability Disclosure, Help The test is fairly solid. Specificity: the ability of a test to correctly identify people without the disease. Patients who underwent arthroscopy to assess suspected meniscal or meniscal together with ACL injuries. 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. Grade III: The joint space opens 5 . Level II, case-control study. Anderson and Lipscomb5 used consecutive patients who were suspected of having a meniscal tear; however, these authors excluded subjects who had associated ligamentous injuries (as demonstrated by arthroscopy) from the statistical analysis. 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). MjI0NTIxNTI4MWM3YmNjNGMwMDU2Mjk4ZWM1MzcyMDNkZTAyYmNhMDljZTU1 Sensitivity, specificity, and likelihood ratios (LR) of the McMurray's test with confidence intervals (CI). The confidence interval (CI) attests to the precision of this estimate11. [1]. There is conflicting evidence in the literature over the accuracy of MRI. Comparison of likelihood ratio's for McMurray's test with modified tests. 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. Published by Elsevier Inc. All rights reserved. Three studies used only one tester4,5,25, and two studies did not mention how many examiners were used3,24. 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. The technical storage or access that is used exclusively for anonymous statistical purposes. The site is secure. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. St. Louis, MO: Saunders Elsevier;2008. The examiner should passively bend the affected leg to about 30 degrees of flexion. eCollection 2018 May. Those that do not include consecutive patients and those that exclude different pathologies may have biased results. MGY4MmExODg4MDUwZTk2NzUzNjQ0OTMxYjkxN2QwYjQ5MmMxODdmMWU4MDdi 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. Results also indicate that testing for medial meniscal pathology is more sensitive than testing for lateral; however, tests for lateral meniscal pathology are more specific than tests for medial pathology3,4,19. Notes Maximum dorsiflexion locks the subtalar joint and improves the sensitivity of this test. Given the results of the multivariate regression in Question 1, write the regression equation associated with this study. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. It is primary restraint to varus rotation from 0-30 of knee flexion. Before ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh Sensitivity and specificity rely on a single threshold for classifying a test result as positive or negative. Boeree NR, Ackroyd CE. NjZjMWViMWE5MzNlMDFhOTA3YzAwYzUzODYzZmQyZGI2ODk1ZmJlOGM4YzZh As a library, NLM provides access to scientific literature. 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). 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. Fowler and Lubliner22 had a similarly broad population in that they included consecutive patients who warranted arthroscopic examination for any reason. Fowler PJ, Lubliner JA. Whiting WC, Zernicke RF. 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. Please enable it to take advantage of the complete set of features! 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. [7] It is commonly associated with other knee ligament injuries, thus LCL tear can be easily overlooked as a result of that. Test Position: Supine. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Generally, the McMurray's test has relatively high specificity and low sensitivity. ZDIwNGI3MGM0NDMzZmMxM2YxZDdmZWM0YmE5MDI5OWJiMmE4MmFhZTdkODE1 There . Physical examination of the knee, inThe Sports Medicine Resource Manual, Editors: Seidenberg, P.H & Beutler, A..I. 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. One study used a palpable thud and/or pain23, and two studies used a palpable click and/or pain3,20. Harilainen A. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi Acute knee injuries: use of decision rules for selective radiograph ordering. Limits human and English. Study with Quizlet and memorize flashcards containing terms like Ballottement, Valgus Stress Test, Varus Stress Test and more. These studies have hypothesized that by incorporating aspects of varus/valgus stress and/or axial loading into the original McMurray's test, there is an increase in diagnostic value3,5,6. Miller GK. Check for excessive gapping and if you can reproduce the patients pain. YWQ2ODI0ODM5NzE5MzVlYTlmMTRmMWEzM2NlYmU4OTViYTkwOTBmNjVjZGFj National Library of Medicine So, little is known about the validity of this test. No mention acute/chronic. Kane PW, Cinque ME, Moatshe G, Chahla J, DePhillipo NN, Provencher MT, LaPrade RF. 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. 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. 3rd edition. 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. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. Bhandari M, Guyatt GH. The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur. 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. The use of the STARD tool is also a limitation. Methodology and description of the 11 studies investigating validity and clinical accuracy of McMurray's test for meniscal pathology. Sensitivity: 25%. 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. 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. Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. 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. 269-273). (2007)Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. As the knee goes into flexion, the LCL loses its significance and influence as a varus-stabilizing structure. These authors demonstrated significantly larger (better) positive likelihood ratios and significantly smaller (better) negative likelihood ratios than the McMurray's. The sensitivity of diagnosing an FCL injury based on varus stress radiographs was also determined. 2017 Mar;101(Suppl 1):23-35. doi: 10.1007/s12306-017-0460-5. IR of the tibia + Varus stress = lateral meniscus. Meserve BB, Cleland JA, Boucher TR. 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 Evans PJ, Bell GD, Frank CY. When refering to evidence in academic writing, you should always try to reference the primary (original) source. The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). 2nd ed. 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. The MCL and LCL are tested with a valgus and varus stress, respectively, with the knee held at 30 of flexion to isolate the collateral ligaments. 1987; 76: 269-273. 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 . In chronic injuries, this test has a sensitivity of 92% and a specificity of 91%, but not in acute injuries. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. 1, This website is powered by SportsEngine's. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. Each test is repeated with the knee in full extension. MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 Intertester reliability of clinical judgements of medial knee ligament integrity. How to appraise a diagnostic test. Assessment of the menisci and cruciate ligaments: An audit of clinical practice. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. Accessibility Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw Cinque ME, Geeslin AG, Chahla J, Moatshe G, Pogorzelski J, DePhillipo NN, LaPrade RF. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. The description of a test within a study should be sufficient to enable replication of the test by practitioners and subsequent researchers. Sensitivity and specificity of a test. That is usually the journal article where the information was first stated. eCollection 2019 Feb. [4, 6] Thessaly Test. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. 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. They rated the sensitivity at 25% and could not report any specificity percentage. MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. True positive: the person has the disease and the test is positive. DOI https://doi.org/10.1016/C2009-1-59662-1. An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). 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. YzQ2ZWY3MDkyMmRjMWVjYzY3ODhjNTExZjU4NGIzMTJjNjA3ZDA5Mzk3NTFl Whenever suspecting a posterolateral complex injury, one has to carefully perform a valgus stress test in 0 degrees and 30 degrees. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. 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. . Anterior cruciate ligament reconstruction: MR imaging findings. The .gov means its official. Orthop J Sports Med. Performed at 900 of knee flexion, and has a sensitivity of 90% and a specificity of 99% Isolated PCL translate > 10-12mm in neutral and >6-8mm in internal rotation. The reliability of this test in extension is 68% and in 30 flexion only 56%. Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. A consensus method was used to discuss and resolve discrepancies between the markings of each paper between the three reviewers. ZDFjNGQ5ZTg3MjdkZDAxOTE5MTYxNDQ3NmIzYzNhZjE4ZjAwNDc4M2NiMzEz Although sensitivity and specificity values provide useful information, they work against the direction of clinical testing11. Common terms. Place the affected leg in extension and slight external rotation. This generic search strategy was then combined with a subject-specific strategy (Table (Table1).1). [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. MRI has also shown to be highly reliable, but due to its expensive cost, they are less frequently used. The test has therefore often been reported to be of limited value in current clinical practice. MeSH All had persistent symptoms at least 8 weeks post-injury. 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). 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. However, of those that have made this distinction, there is some consensus that the McMurray's test has higher sensitivity with respect to medial meniscal tears and higher specificity with lateral meniscal tears3,4,19,20,24. 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. 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. 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. Bethesda, MD 20894, Web Policies The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is unlocked.1. So, little is known about the validity of this 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. Piantanida, A.N. The accuracy of the clinical knee examination documented by arthroscopy: A prospective study. The reliability of this test in extension is 68% and in 30 flexion only 56%. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. Bethesda, MD 20894, Web Policies Usually medial angulation of both femur and tibia is involved. 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. Collectively, these studies indicate that there is little consensus in the reported measures of validity of the McMurray's test and that this is mostly due to limitations in the methodological quality of the studies that were assessed. ZTU5MGVlOWM4MDcwMGE2YmJiZjNjZTBiMjQ2N2E5OTFmNTliZDgyYzc4ZjQ0 [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. 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). M2NhODMyZGZjNTEwMzAzY2JkMWI0MTUwM2I3NjNjN2RjYmY4NmEyNWE1ZjZk Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. Orthopaedics - A guide for practitioners. 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%. Malagelada F, Vega J, Golano P, Beynnon B, Ertem F. Knee Anatomy and Biomechanics of the Knee. Enroll in our online course: http://bit.ly/PTMSK DOWNLOAD OUR APP: iPhone/iPad: https://goo.gl/eUuF7w Android: https://goo.gl/3NKzJX GET OUR ASSESSMENT B. 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. ZmNhYzI5Njc5MTEwZGU2NTAzYmRjNmJiODlmMmU0N2FhYzFhMDRjNjQ1YTNk 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. -----BEGIN REPORT----- Four authors stated that they used the McMurray's test but did not describe the actual testing procedure3,5,19,25. One of the search terms used was McMurray$ test$. [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. A prospective evaluation of a test for lateral meniscal tears. 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.
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