The Diagnostic Value of the Clarke Sign in Assessing Chondromalacia Patella

Abstract

Context: Various techniques have been described for assessing conditions that cause pain at the patellofemoral (PF) joint. The Clarke sign is one such test, but the diagnostic value of this test in assessing chondromalacia patella is unknown.Objective: To (1) investigate the diagnostic value of the Clarke sign in assessing the presence of chondromalacia patella using arthroscopic examination of the PF joint as the ''gold standard,'' and (2) provide a historical perspective of the Clarke sign as a clinical diagnostic test.Design: Validation study. Setting: All patients of one of the investigators who had knee pain or injuries unrelated to the patellofemoral joint and were scheduled for arthroscopic surgery were recruited for this study.Patients or Other Participants: A total of 106 otherwise healthy individuals with no history of patellofemoral pain or dysfunction volunteered.Main Outcome Measure(s): The Clarke sign was performed on the surgical knee by a single investigator in the clinic before surgery. A positive test was indicated by the presence of pain sufficient to prevent the patient from maintaining a quadriceps muscle contraction against manual resistance for longer than 2 seconds. The preoperative result was compared with visual evidence of chondromalacia patella during arthroscopy.Results: Sensitivity was 0.39, specificity was 0.67, likelihood ratio for a positive test was 1.18, likelihood ratio for a negative test was 0.91, positive predictive value was 0.25, and negative predictive value was 0.80. Conclusions:Diagnostic validity values for the use of the Clarke sign in assessing chondromalacia patella were unsatisfactory, supporting suggestions that it has poor diagnostic value as a clinical examination technique. Additionally, an extensive search of the available literature for the Clarke sign reveals multiple problems with the test, causing significant confusion for clinicians. Therefore, the use of the Clarke sign as a routine part of a knee examination is not beneficial, and its use should be discontinued.

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

“…Although the patellofemoral grind test has been suggested as a method for detecting chondromalacia patella or patellofemoral pain syndrome, the test is poorly validated for this, and its significance has been questioned . A recent study showed that the typical clinical examination measures (patellofemoral crepitus and pain with patellofemoral compression) that were commonly thought to represent underlying patellofemoral joint pathology did not discriminate knees with patellofemoral OA from knees with tibiofemoral OA or without OA .…”

“…The patellofemoral grind test is a simple clinical test used in practice for the evaluation of anterior knee pain. In this setting, a positive test may suggest the presence of chondromalacia patella or patellofemoral pain syndrome . Such a positive test, however, is a purely theoretical construct.…”

Characteristics and Outcome of Patellofemoral Pain in Adolescents: Do They Differ From Adults?

“…16 Additionally, the presence of pain with palpation of the apex and medial facet of the patella (yes or no) was assessed, and Clarke's compression test was performed (positive or negative). 6 Strength of the quadriceps and hip musculature for abduction and external rotation was measured using a handheld dynamometer (MicroFET2; Fabrication Enterprises Inc, Elmsford, NY), which is a reliable method to measure strength in individuals with PFP. 18 Strength measurements were repeated 3 times, and the mean of the highest 2 values was used for analyses (Newton meters per square centimeter).…”

Intra- and Inter-session Reliability of Static and Dynamic Postural Control in Participants with and without Patellofemoral Pain Syndrome

“…The presence of pain indicated a positive diagnosis. 19 Participants with a history of neuromuscular or musculoskeletal disorders; any balance, vestibular, or visual problems; or a significant injury to either lower extremity aside from unilateral PFPS were excluded from the study. The study was approved by the ethics committee of the University of Social Welfare and Rehabilitation Sciences, and all participants provided written informed consent.…”