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The Paradoxical McMurray Test for the Detection of Meniscal TearsAn Arthroscopic Study of Mechanisms, Types, and Accuracy
Sung-Jae Kim, MD, PhD1; Byoung-Yoon Hwang, MD1; Duck-Hyun Choi, MD1; Yu Mei, MD1
1 Department of Orthopaedic Surgery and the Arthroscopy & Joint Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea. E-mail address for Y. Mei: pkumeiyu@gmail.com
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Investigation performed at the Arthroscopy & Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University Health System, Seoul, South Korea



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Aug 15;94(16):e118 1-7. doi: 10.2106/JBJS.K.00356
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Abstract

Background: 

Meniscal tears are very common. The so-called paradoxical McMurray test has been described and found to be positive for three different types of meniscal tears. However, to our knowledge, no study has evaluated the accuracy of this test. The purpose of the present study was to evaluate the accuracy of the paradoxical McMurray test compared with the conventional McMurray test. We also sought to determine whether there are other types of meniscal tears that would show positive results on the paradoxical McMurray test.

Methods: 

The authors evaluated 628 patients with meniscal tears (Group I) and 387 patients without meniscal tears (Group II), as confirmed by arthroscopy performed from June 2000 to May 2006. The results of both clinical examinations (the conventional and the paradoxical McMurray test) were recorded, and the paradoxical phenomenon as seen during arthroscopy was described. The sensitivity and specificity of each test were calculated and statistically analyzed.

Results: 

The average patient age (and standard deviation) was 41.9 ± 15.6 years (range, ten to sixty-six years) in Group I and 40.3 ± 12.9 years (range, fifteen to sixty-three years) in Group II. The sensitivities of the McMurray test and the paradoxical McMurray test for diagnosing a meniscal tear were 41.9% (263 of 628) and 12.3% (seventy-seven of 628), respectively. The specificities of the two tests were 76.7% (297 of 387) and 99.2% (384 of 387), respectively. Compared with the conventional McMurray test, the paradoxical McMurray test showed significantly lower sensitivity but higher specificity. Apart from the three previously reported types of meniscal tears, a new type of meniscal tear in a discoid lateral meniscus also showed positive results with the paradoxical McMurray tests.

Conclusions: 

In conclusion, a positive paradoxical McMurray test is reliable for diagnosing a meniscal tear that has a large displaced meniscal flap. A long radial tear in the posterior one-third of the discoid lateral meniscus is a new type of meniscal tear with positive results on the paradoxical McMurray test.

Level of Evidence: 

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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