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Review: Physical diagnostic tests have low diagnostic accuracy for meniscal lesions of the knee

Stanford Shoor, MD
[+] Article, Author, and Disclosure Information

Source of funding: No external funding.

For correspondence: Dr. R.J.P.M. Scholten, Dutch Cochrane Centre, Amsterdam, The Netherlands. E-mail R.J.Scholten@AMC.UvA.NL.

Ann Intern Med. 2002;136(3):113. doi:10.7326/ACPJC-2002-136-3-113
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Question: In patients with meniscal lesions of the knee, what is the diagnostic accuracy of physical diagnostic tests?

Data sources: Studies were identified by searching MEDLINE (1966 to 1999) and EMBASE/Excerpta Medica (1988 to 1999) with terms describing knee joint, knee, menisci tibial, and effusion. Bibliographies of relevant studies were scanned.

Study selection: 2 reviewers independently selected studies that were published in English, French, German, or Dutch; reported the accuracy of ≥ 1 physical diagnostic test for the assessment of meniscal lesions of the knee; and used arthrotomy, arthroscopy, or magnetic resonance imaging (MRI) as the diagnostic standard. Studies were excluded if they did not have a reference group, included only persons with positive test results, pertained to cadavers only, or considered physical examination under anesthesia only.

Data extraction: 2 reviewers independently assessed the quality of study methods and extracted data on the spectrum of lesions, number of patients, patients’ ages, duration of symptoms, prevalence, sensitivity, specificity, and likelihood ratios.

Main results: 13 studies (2231 patients) were included. The index test and diagnostic standard were assessed blindly in 2 studies. 9 studies used arthroscopy and 1 study used MRI as the diagnostic standard. Verification bias (i.e., patients with an abnormal physical test finding had a greater likelihood of receiving the diagnostic standard) was present in most studies. The Table shows the ranges for sensitivity, specificity, and likelihood ratios for the joint effusion test (4 studies), the McMurray test (11 studies), the joint line tenderness test (13 studies), and the Apley compression test (4 studies).

Conclusion: In patients with meniscal lesions of the knee, physical diagnostic tests have low diagnostic accuracy.

Test characteristics for diagnosing meniscal lesions of the knee*

TestsNumber of studiesSensitivity rangeSpecificity range+LR range−LR range
Joint effusion420% to 53%54% to 100%0.8 to ∞0.7 to 1.1
McMurray test1110% to 66%57% to 98%1.5 to 9.50.4 to 0.9
Joint line tenderness1328% to 95%5% to 95%0.8 to 14.90.2 to 2.1
Apley compression test416% to 58%80% to 99%0.8 to 19.50.5 to 1.1

*Diagnostic terms defined in Glossary.





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