Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. Limitations of this review relate to the search strategy used. Performance: A varus stress test is performed by stabilizing the femur and palpating the lateral joint line. Sensitivity: 25%. The fibular or lateral collateral ligament (LCL) is a cord-like band and acts as the primary varus stabilizer of the knee. 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. Purpose: Anterior cruciate ligament reconstruction: MR imaging findings. The accurate diagnosis of meniscal pathology on the basis of the findings of such tests is often difficult. Studies were included for analysis if they compared the McMurray's test with a gold standard of knee arthroscopy or magnetic resonance imaging (MRI). 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. 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. Sensitivity & Specificity Sensitivity: 66 % Specificity: 60 % A study on 21 patients referred with chronic medial collateral ligament injuries, the Valgus stress test at 30, 60, 70, or 90 degrees of elbow flexion was performed (The Reference Standard was Surgical visualization ). 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. If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. Further, subjects who are positive on the reference standard should reflect a continuum of severity, whereas those who are negative should have conditions commonly confused with meniscal tears17. Three independent reviewers assessed each of the papers included in the review, and an overall STARD score of methodological quality was determined for each paper. A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. M2EwZWY0Zjg3ZDdlZTMzNDhjY2EwMzdkMmRjZmQ1M2M1OTI3ZDRiZDk0NzYx 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. 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). The Valgus Test of the knee is performed with the patient lies in the supine position. I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). As a library, NLM provides access to scientific literature. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi NjZjMWViMWE5MzNlMDFhOTA3YzAwYzUzODYzZmQyZGI2ODk1ZmJlOGM4YzZh YzQ2ZWY3MDkyMmRjMWVjYzY3ODhjNTExZjU4NGIzMTJjNjA3ZDA5Mzk3NTFl YTY1NDM4NjNkYzAwMmMxNGU2MjgwMmMzODFlMTZkZmQyYjRmNTAzM2RkZWY4 Before There is conflicting evidence with respect to the effect of the presence of an associated anterior cruciate ligament (ACL) deficiency. YzZhYjViODEyOTFlYzkyIn0= When confidence intervals are not present, the CIs were incalculable due to absence of raw data. ODA3OTUwYWUyMzM0ODhjYWM2MzMzZDc4YTcxNWI4Njc5NDlmMTE2NjIxOTc0 This site needs JavaScript to work properly. Mariani PP, Adriani E, Maresca G, Mazzola CG. eCollection 2018 May. Epub 2017 Feb 14. 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. 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. N2IwYjAxYmE3NzM4ZmE2MTE5MTMyY2Q0M2I3NTQ5YjlkMzU3ODI3ODIyNzg0 government site. Churchill Livingstone, 2002. A control group was composed of patients with an MRI and intact ACL and FCL. Consecutive patients scheduled for menisectomy; acute and chronic. followers. official website and that any information you provide is encrypted Arthroscopy. Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw Conclusions: 1st ed. 8600 Rockville Pike ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz Likelihood ratios overcome some of the problems involved with sensitivity and specificity values by summarizing the information contained in these values in a manner that can be used to quantify shifts in probability once the meniscal test results are known28. How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt. The external validity of a study is largely dependent on the study population. Likelihood Ratios with confidence: Sample size estimation for diagnostic test results. Level II, case-control study. The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is unlocked.1. If you believe Wordfence should be allowing you access to this site, please let them know using the steps below so they can investigate why this is happening. A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). Campbell SE, Sanders TG, Morrison WB. Epub 2017 Aug 16. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. . A recent study by Akseki et al3 reported high combined sensitivity and specificity figures (63% and 83%, respectively) and relatively narrow confidence intervals (Table (Table5).5). The reliability of this test in extension is 68% and in 30 flexion only 56%. Test Position: Supine. The four possible outcomes include true positive, a false positive, a false negative, and a true negative (see Table Table2).2). Bhandari M, Guyatt GH. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. 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). Consider the use of modifications of the test for improved validity. 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. ZTY2MWNjMWEzNTQ3MTc4OGU3ZWFmY2NhNWFkNDczMWFlOGI3ZDgwMTBkOGFj True negative: the person does not have the disease and the test is negative. 2019 Jan 21;8(2):e141-e145. DOI https://doi.org/10.1016/C2009-1-59662-1. 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. 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. Methodology and description of the 11 studies investigating validity and clinical accuracy of McMurray's test for meniscal pathology. St. Louis, MO: Saunders Elsevier;2008. 2022 Jun 6;10(6):23259671221100216. doi: 10.1177/23259671221100216. NWYxMjQ3NzE3ZWM2MGI5ODE2MGE0ZWZkNmNjZmQxNWM0M2JiYjFlZTJlNWQ5 Six of the studies within this review included consecutive patients (Table (Table4).4). The same maneuvers are performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the menisci. Studies by Boeree and Ackroyd19, Akseki et al3, and Karachalios et al21 demonstrated small but sometimes important shifts in probability. The review also highlights the idea that modified versions of the test seem to be more valid than the original version. 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. Described a modified version (Medial-Lateral Grind test) but no description of McMurray's. 1173185. Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears. A recent meta-analysis illustrates the difference in test characteristics when performed on patients under anesthesia. 2018 May 2;6(5):2325967118770170. doi: 10.1177/2325967118770170. Karachalios et al21 incorrectly added valgus or varus stress as a component of the McMurray's. With regard to negative likelihood ratios, all but three of the studies demonstrated only a small alteration in probability that a subject with a negative McMurray's test will not have a meniscal tear (Table (Table5).5). Currently, a triple phase technium-99 bone scan (scintigraphy) is the most accurate method of diagnosing stress fractures with a sensitivity of 100% and specificity of 76%. The objective of this paper was to critically review the literature with respect to the validity and diagnostic accuracy of the traditional McMurray's test and any modifications of this test. Ciba M, Winkelmeyer EM, Schock J, Westfechtel S, Nolte T, Knobe M, Prescher A, Kuhl C, Truhn D, Nebelung S. Sci Rep. 2022 Jul 13;12(1):11858. doi: 10.1038/s41598-022-15787-2. Orthopedic Physical Assessment: 5 th Edition. Medline and CINAHL search strategy via OVID. 3rd edition. Ocassionally, the LCL is congenitally absent. Use of methodological standards in diagnostic test research: Getting better but still not good. Specificity: not reported. Generally, the McMurray's test has relatively high specificity and low sensitivity. Evaluation of knee instability in acute ligamentous injuries. HHS Vulnerability Disclosure, Help Bookshelf Studies that have evaluated the sensitivity and specificity of individual clinical tests to detect ligamentous injury, . Biomechanics of musculoskeletal injury. Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. ODFlNzFkZTQ2MDZmOTVkM2Q1MjEzNzY5YTlmZTU2MTRmYWFkYzY2ZmRmNzlj Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. These authors demonstrated significantly larger (better) positive likelihood ratios and significantly smaller (better) negative likelihood ratios than the McMurray's. [4, 6] Thessaly Test. 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. Physical examination of the knee, inThe Sports Medicine Resource Manual, Editors: Seidenberg, P.H & Beutler, A..I. Patients who underwent arthroscopy to assess suspected meniscal or meniscal together with ACL injuries. Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. The .gov means its official. However, they only included patients who had had symptoms for at least one year, making extrapolation of their findings to the acute population challenging. 1173185. 2006;20:8594. 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. NTc3ODRiOTRjOGU4N2ExOGU2NDEzYWVjZmNiMTQ1N2FjM2U4NjVmMzhlMzRi Described a modified version (Ege's test) but no description of McMurray's. OThmMmM0YTcwMmQwODZhZWFkYzNjNzRlOTkzZiIsInNpZ25hdHVyZSI6IjVh The IR of the tibia followed by extension, the examiner can test the entire posterior horn to the middle segment of the meniscus. 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. Anderson and Lipscomb5 compared the McMurray's test to a test termed the Medial-Lateral Grind test that included a varus/valgus component not included in the original McMurray's test. The preliminary nature of this tool also means that a more narrative review of the validity and accuracy of the tests has been presented. 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. This means that tests rarely have both high sensitivity and specificity. In extension, the posterior capsule and cruciate ligaments act as secondary restraints for varus stress. the contents by NLM or the National Institutes of Health. The description of a test within a study should be sufficient to enable replication of the test by practitioners and subsequent researchers. In addition, cited references of relevant articles were examined. ZDZkZjczMGZkNzQ1OWMxZTQyNDY2ZTAzYTM5OTk2ZmQ1YjkzNDFjMDhmNzMy The physiotherapist stabilize the knee with one hand, while the other hand adducts the ankle.[10]. These findings are contrasted by those of Karachalios et al21, who reported a 95% agreement for both intra- and intertester reliability for all of the clinical tests they employed. and transmitted securely. Sensitivity figures vary from 16%88%, while specificity figures vary from 20%98% (Table (Table5).5). M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm eCollection 2022 Jun. In general, sensitivity figures are much lower than specificity and the CI limits are wider. 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). Simmel DL, Samsa GP, Matchar DB. Once again, this affects the generalizability of the findings. Of the four studies that demonstrated the highest shifts in probability, only Corea et al4 and Akseki et al3 contained calculable CIs, which were relatively narrow (Table (Table55). ZTU5MGVlOWM4MDcwMGE2YmJiZjNjZTBiMjQ2N2E5OTFmNTliZDgyYzc4ZjQ0 Measures of efficacy include accuracy, sensitivity, and specificity. The final two studies20,21 limited their study population to patients suspected of meniscal injury. There is conflicting evidence in the literature over the accuracy of MRI. Those that do not include consecutive patients and those that exclude different pathologies may have biased results. Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. Jaeschke RZ, Meade MO, Guyatt GH, Keenan SP, Cook DJ. The differences in study populations are likely to have contributed to the wide variability of results across studies. Orthop J Sports Med. Harilainen A. Additionally, the single photon-emission CT scan is receiving a lot . official website and that any information you provide is encrypted MGY4MmExODg4MDUwZTk2NzUzNjQ0OTMxYjkxN2QwYjQ5MmMxODdmMWU4MDdi To evaluate the diagnostic accuracy of magnetic resonance imaging and varus stress radiographs for fibular collateral ligament (FCL) tears, and compare these modalities to intraoperative findings. Inclusion in an NLM database does not imply endorsement of, or agreement with, Value of the physical examination. Saunders Elsevier. The technical storage or access that is used exclusively for statistical purposes. The Journal of Manual & Manipulative Therapy. No valgus or varus stress is applied. Sensitivity and specificity of a test. Of the 11 studies identified in this review, nine used arthroscopy as the reference standard, one used MRI, and the remaining study used both MRI and arthroscopy (Table (Table44). St. Louis, MO: Saunders Elsevier;2008. This is true in the case of the study by Akseki et al3 but not for the study by Evans et al23 (Tables (Tables44 and and55). Piantanida, A.N. 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). National Library of Medicine eyJtZXNzYWdlIjoiMDAzMWIwNTU1ZDk0ZjIzMGU1NDkwYzhmOWYxZTk0YWI3 24 General examination included carrying angle (normal, valgus,. The inclusion of patients with different pathologies would make the results of studies more generalizable to the clinical setting. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. Examining diagnostic tests: An evidence-based perspective. The best statistics for summarizing usefulness of a diagnostic test appear to be likelihood ratios (LR)17. Fowler and Lubliner22 attributed their low sensitivity results (compared to previous studies)5,25 to population differences between the studies (Table (Table5).5). The most sensitive test used in the diagnostics of medial meniscus lesions was the McMurray test, which showed a sensitivity of 87.5% with 52% specificity. Acute patients (< 6 weeks) excluded. [8]The test has therefore often been reported to be of limited value in current clinical practice. Varus Stress Test Purpose: To assess the integrity of the LCL. Usually medial angulation of both femur and tibia is involved. Unable to load your collection due to an error, Unable to load your delegates due to an error. -----END REPORT-----. 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. Based on MRI, overall specificity was 68%. The other hand provides a varus stress to the ankle. . However, these authors stated that they determined these findings in a study of 20 subjects prior to the main study and they did not provide any details of how this pilot study was performed or analyzed. Relatively narrow confidence intervals also attest to the reliability of these two studies3,4 (Table (Table55). Evidence-Based Medicine: How to Practice and Teach EBM. Check for excessive gapping and if you can reproduce the patients pain. [3] McClure P,W et al. Careers. . Meserve BB, Cleland JA, Boucher CT. A meta-analysis examining clinical test utilities for assessing meniscal injury. [4] The popliteus tendon is deep to the LCL, seperating it from the lateral meniscus. followers, 712k 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. 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. ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 The acute tears frequently result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee.[3]. The proportion of people who test positive and who have the disease or dysfunction. Consecutive patients. Useful tests should produce large shifts in probability once the result of the test is known. 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. While some studies have stated that greater clinical experience aids correct diagnosis3,5,19, the only current statistical evidence in this regard shows no difference between an experienced and inexperienced tester 23. In most cases Physiopedia articles are a secondary source and so should not be used as references. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. 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. Evidence. 2008. = (Number of TP + Number of TN)/(Numbers of TP + FP + FN), Identifies article as a study of diagnostic accuracy, Describes study population (inclusion criteria, exclusion criteria, settings, locations), Describes data collection (prospective or respective), Describes reference standard and rationale, Describes technical Specifications of material and methods involved, Describes definition and rationale of units, cut-of points, or categories of results of tests, Describes number, training, and expertise of raters. Accessibility [5], The LCL stabilizes the lateral side of the knee joint, mainly in varus stress and posterolateral rotation of the tibia relative to the femur. The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes. Careers, Unable to load your collection due to an error. ZmNhYzI5Njc5MTEwZGU2NTAzYmRjNmJiODlmMmU0N2FhYzFhMDRjNjQ1YTNk Diagnosis of acute knee ligament injuries: The value of stress radiography compared with clinical examination, stability, under anesthesia and arthroscopic or operative findings. Clinical diagnosis of meniscal tears: Description of a new manipulative test.
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