An article, discussing a new test for meniscal integrity, was recently brought to our attention. As you know, there is only one single-test for meniscus tears that has adequate diagnostic accuracy: Thessaly Test. It has a sensitivity of .89 and specificity of .92. The issue with this technique is that it can increase the tear (the test actually mimics the mechanism of injury). Another common test we see is Joint Line Tenderness, but this test has a sensitivity of .63 and specificity of .77. While this test alone is insufficient, when clustered with several other tests, the diagnostic accuracy greatly improves. The cluster includes: history of joint locking, Joint Line Tenderness, McMurray's Test, pain with flexion overpressure, and pain with extension overpressure.
The article we looked at discusses using Joint Line Fullness as a clinical test. The patient is supine and the examiner palpates along the affected joint line to compare fullness to the uninjured side. If the joint line fullness causes a loss of joint compression, the test is positive. The lateral side of the knee is examined in 30-45 degrees of knee flexion to slacken the IT Band, while the medial side of the knee is examined at 70-90 degrees of knee flexion to slacken the MCL. The test had a sensitivity of .70 and specificity of .82. Again, by itself, this test's accuracy is still lacking. One might argue that it could potentially replace Joint Line Tenderness in the cluster to increase the diagnostic accuracy even more, however, we must look at the methods of the study first. The study excluded any patients with an acute injury (within 6 weeks of exam) or presence of osteophytes, joint space loss, or arthritis. Due to the fact that we often see our patients in the acute stage within 6 weeks of injury and frequently our patients have arthritis, the findings of this study become questionable. If many of our patients are bound to have the exclusion criteria, will the test still prove useful? Now, we are not suggesting that the test has no usefulness, but perhaps an additional study should be performed, where these patients are included.
Couture JF, Al-Juhani W, Forsythe ME, Lenczner E, Marien R, Burman M. (2012). Joint line fullness and meniscal pathology. Sports Health. 2012 Jan;4(1):47-50. Web. 14 May 2013.
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