Special tests for assessing meniscal tears within the knee: a systematic review and meta-analysis

Abstract

Background Musculoskeletal knee pain is a large and costly problem, and meniscal tears make up a large proportion of diagnoses. 'Special tests' to diagnose torn menisci are often used in the physical examination of the knee joint. A large number of publications within the literature have investigated the diagnostic accuracy of these tests, yet despite the wealth of research their diagnostic accuracy remains unclear. Aim To synthesise the most current literature on the diagnostic accuracy of special tests for meniscal tears of the knee in adults. Method An electronic search of MEDLINE, Cumulative Index to Nursing and Allies Health Literature (CINAHL), The Allied and Complementary Medicine Database (AMED) and SPORTDiscus databases was carried out from inception to December 2014. Two authors independently selected studies and independently extracted data. Methodological quality was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) 2 tool. Results Nine studies were included (n=1234) and three special tests were included in the meta-analysis. The methodological quality of the included studies was generally poor. McMurray's had a sensitivity of 61% (95% CI 45% to 74%) and a specificity of 84% (95% CI 69% to 92%). Joint line tenderness had a sensitivity of 83% (95% CI 73% to 90%) and a specificity of 83% (95% CI 61% to 94%). Thessaly 20°had a sensitivity of 75% (95% CI 53% to 89%) and a specificity of 87% (95% CI 65% to 96%). Conclusions The accuracy of the special tests to diagnose meniscal tears remains poor. However, these results should be used with caution, due to the poor quality and low numbers of included studies and high levels of heterogeneity.

Associations of Joint Line Tenderness and Patellofemoral Grind With Long‐Term Knee Joint Outcomes: Data From the Osteoarthritis Initiative

“…Joint line tenderness is used as a clinical sign of meniscal pathology , an established risk factor for knee OA . It is included as one of the physical examinations for evaluating tibiofemoral OA .…”

“…However, at present the significance of these tests in predicting long‐term outcomes of the knee joint is unknown. For the tibiofemoral compartments, joint line tenderness is commonly used in clinical practice to diagnose meniscal pathology , with a sensitivity of 83% and a specificity of 83% , and meniscal pathology is known to predate the onset and progression of knee OA . One study found no association between joint line tenderness and rapid progression to knee arthroplasty within 3 years in individuals with or at risk for knee OA .…”

Risk factors, diagnosis and non-surgical treatment for meniscal tears: evidence and recommendations: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

“…One systematic review39 with 4 studies40–43 and 11 additional studies44–54 were included (online supplementary table 6). These 15 studies included 2474 patients.…”

Knee Range of Motion as a Discriminatory Tool Indicating Potential Meniscal Tears

“…Currently, no standard criteria exist for referring primary care patients who are experiencing intraarticular knee pain to specialists. [5][6][7] Consequently, orthopedic surgeons are largely responsible for determining whether patients have operable vs manageable knee pain, reducing the time they have available for surgery.…”