Background: Clinical tests used for the detection of meniscal tears
in the knee do not present acceptable diagnostic sensitivity and specificity
values. Diagnostic accuracy is improved by arthroscopic evaluation or magnetic
resonance imaging studies. The objective of this study was to evaluate the
diagnostic accuracy of a new dynamic clinical examination test for the
detection of meniscal tears.
Methods: Two hundred and thirteen symptomatic patients with knee
injuries who were examined clinically, had magnetic resonance imaging studies
performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers
who were examined clinically and had magnetic resonance imaging studies done
of their normal knees were included in this study. For clinical examination,
the medial and lateral joint-line tenderness test, the McMurray test, the
Apley compression and distraction test, the Thessaly test at 5° of knee
flexion, and the Thessaly test at 20° of knee flexion were used. For all
clinical tests, the sensitivity, specificity, false-positive, false-negative,
and diagnostic accuracy rates were calculated and compared with the
arthroscopic and magnetic resonance imaging data for the test subjects and the
magnetic resonance imaging data for the control population.
Results: The Thessaly test at 20° of knee flexion had a high
diagnostic accuracy rate of 94% in the detection of tears of the medial
meniscus and 96% in the detection of tears of the lateral meniscus, and it had
a low rate of false-positive and false-negative recordings. Other traditional
clinical examination tests, with the exception of joint-line tenderness, which
presented a diagnostic accuracy rate of 89% in the detection of lateral
meniscal tears, showed inferior rates.
Conclusions: The Thessaly test at 20° of knee flexion can be
used effectively as a first-line clinical screening test for meniscal tears,
reducing the need for and the cost of modern magnetic resonance imaging
Level of Evidence: Diagnostic Level I. See Instructions
to Authors for a complete description of levels of evidence.