The assessment results for methodological quality has been presented under the following headings: the STARD analysis, reference standard, population differences, blinding, description and interpretation of test, inter-tester reliability, diagnostic accuracy and validity, sensitivity and specificity, likelihood ratios, and McMurray's test compared to modified versions of the test. The sensitivity was 87% for the medial meniscus but only 46% for the lateral meniscus13. In: Campbell's Operative Orthopaedics. ZDZkZjczMGZkNzQ1OWMxZTQyNDY2ZTAzYTM5OTk2ZmQ1YjkzNDFjMDhmNzMy Evans et al23 concluded that examiner experience had little effect on the accuracy of the diagnosis; however, they noted that the student examiner demonstrated a significant association (p = 0.002) between the diagnosis of a medial meniscus tear and reproduction of a medial thud, while the experienced examiner demonstrated a significant association between this diagnosis and the reproduction of pain (p = 0.008) or a medial sensation (p = 0.001). aAssociate Professor, health & Rehabilitation Research Centre, School of Rehabilitation and Occupation Studies, AUT University, Auckland, New Zealand, bSenior Lecturer, School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand, cHead of School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand, dSchool of Physiotherapy, Auckland University of Technology, Auckland, New Zealand. Varus Stress Test of the Knee | Lateral Collateral Ligament Injury The possibility of there being associated intra-articular pathology (such as anterior cruciate ligament rupture) confounds results, and the unknown validity, sensitivity, and specificity of the tests make it difficult for the clinician to be confident in making a definitive diagnosis3. [5] The LCL further splits the biceps femoris into two parts. The .gov means its official. This was a purposeful strategy designed to enhance their ability to determine the true sensitivity and specificity of the McMurray's test in a population that reflects the symptomatic knee cohort that presents clinically. government site. Petty NJ. Once again, this affects the generalizability of the findings. A total of 232 patients were included: 98 patients in the FCL tear group (mean age: 33.6 12.2 years) and 134 patients in the control group (mean age: 44.0 17.2 years). Edinburgh: Elsevier, 2006. Agreement regarding which articles to read in full was determined by consensus. The incidence of LCL injuries are relatively low (6%) when compared to other knee injuries. 1173185. Referred from GP/A&E with suspected cruciate ligament or meniscal pathology. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. As previously documented in the literature10, the definition and calculation of statistical measures of concurrent criterion-validity are based on the absence or agreement between the clinical test and the gold standard test. How to appraise a diagnostic test. Patients suspected of having a meniscal tear on the basis of history and mechanism of injury excluding those with multiple injuries, history of knee surgery, early clinical and radiographic signs of osteoarthritis, articular cartilage injuries, neurological and musculoskeletal degenerative disorders, disorders of the synovium, acute injuries (less than 4 weeks post-trauma), and any abnormal findings on conventional radiographs. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. This means that tests rarely have both high sensitivity and specificity. A prospective evaluation of a test for lateral meniscal tears. The varying definitions of a positive McMurray's test are also likely to have contributed to the variability of the results demonstrated by the studies reviewed. Miller GK. NWYxMjQ3NzE3ZWM2MGI5ODE2MGE0ZWZkNmNjZmQxNWM0M2JiYjFlZTJlNWQ5 Based on the STARD scoring of each paper, it is possible to make a qualitative assessment about the methodological quality. official website and that any information you provide is encrypted MDUwOTJiNWVjMDExNzg5OTRkYzIwNjRlYzdhZmM2MzUyYjUwY2IxYTkzMTRk Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. Please enable it to take advantage of the complete set of features! A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). True negative: the person does not have the disease and the test is negative. Miller RH, Azar FM. The inclusion of patients with multiple pathologies is likely to lessen the diagnostic accuracy of a test; however, this would reflect actual clinical practice6,18. The majority of studies did not report intertester or intratester reliability of the McMurray's test. Currently, a triple phase technium-99 bone scan (scintigraphy) is the most accurate method of diagnosing stress fractures with a sensitivity of 100% and specificity of 76%. An LR+ indicates the degree of certainty that a patient with a positive test actually has the suspected condition while an LR indicates the degree of certainty that a patient with a negative test does not have the suspected condition27. MDYzNWEzNGQxNDFiMmU0MDBmMmJkZTU4YzNiNzE1MWYxNWM3ZGU1NzFkM2Zm The proportion of people who test positive and who have the disease or dysfunction. Review of meniscal injury and associated sports. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. Arthroscopy has demonstrated an accuracy between 93% and 96%12. Sensitivity and specificity of diagnosing FCL injuries on MRI were determined based on review by a fellowship-trained musculoskeletal radiologist, blinded to the pathology associated with each patient (FCL injury vs control), and compared with the gold standard of examination under anesthesia, followed by surgical confirmation of an FCL tear at the time of FCL reconstruction. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). The same maneuvers are performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the menisci. Am J Sports Med. Sensitivity, specificity, and likelihood ratios (LR) of the McMurray's test with confidence intervals (CI). How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt. Increased Accuracy of Varus Stress Radiographs Versus Magnetic Resonance Imaging in Diagnosing Fibular Collateral Ligament Grade III Tears. Bearing these findings in mind, the following recommendations can be made for the clinician: This review has demonstrated that the intertester reliability and sensitivity of the McMurray's test is relatively low; however, it has also highlighted that it can be a relatively specific test, especially with respect to the lateral meniscus. In addition, cited references of relevant articles were examined. In order to make the retrieval of articles as comprehensive as possible, a generic search strategy was employed using Medline, CINAhL, and AMED databases through OVID, SPORTDiscus database through EBSCO, and SCOPUS, from 1980 to May 2008. YzA0Nzk1ZjQxYjY5Mzg4MWUwNDRlODM0NDRiNzZiM2I4OWVhNTQ1YmVlMDNj PDF ssslideshare.com It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. ZDIwNGI3MGM0NDMzZmMxM2YxZDdmZWM0YmE5MDI5OWJiMmE4MmFhZTdkODE1 Muellner T, Weinstabl R, Schabus R, Vecsei V, Kainberger F. The diagnosis of meniscal tears in athletes: A comparison of clinical and magnetic resonance imaging investigations. (2007)Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. While some studies have stated that greater clinical experience aids correct diagnosis3,5,19, the only current statistical evidence in this regard shows no difference between an experienced and inexperienced tester 23. Varus stress radiographs were determined to be more sensitive in diagnosing FCL injuries compared with MRI, with an overall sensitivity of 70% compared with 66%, respectively. Walters J, editor. Accessibility and transmitted securely. . Epub 2017 Feb 14. [3] McClure P,W et al. Waldman,S.D. At the proximal level this ligament is closely related to the joint capsule, without having direct contact, as it is separated by fat pad, The insertion is augmented by the iliotibial band. High specificity indicates that a test can be used for including a condition when it is positive26. An official website of the United States government. Varus stress test video provided by Clinically Relevant, Additional tests for detecting LCL injury with other knee ligaments:[6], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. This is true in the case of the study by Akseki et al3 but not for the study by Evans et al23 (Tables (Tables44 and and55). The review suggests that modifications of the interpretation of a positive test to include reproduction of pain either as well as or on its own may enhance the validity of the test. 2nd ed. Some studies have attempted to compare the diagnostic value of the McMurray's test to that of modified tests. 2022 Jun 6;10(6):23259671221100216. doi: 10.1177/23259671221100216. The low sensitivity figures would indicate that in general, a negative test result is not reliable in ruling out meniscal pathology and a torn meniscus would likely be missed if the McMurray's test was the sole determinant of pathology. Kurosaka et al6 stated that diagnostic accuracy is lessened in patients with multiple pathologies, whereas Akseki et al3 found that there was no reduction in diagnostic accuracy with an associated tear of the ACL. In testing the accuracy of a clinical test like the McMurray's test, ideally the study participants should consist of individuals who would be likely to undergo the test in clinical practice and who have a reasonable chance of having the condition16. LaPrade RF, DePhillipo NN, Cram TR, Cinque ME, Kennedy MI, Dornan GJ, O'Brien LT. Am J Sports Med. Evidence-Based Medicine: How to Practice and Teach EBM. Akseki et al3 compared the McMurray's test with a weight-bearing version of the McMurray's test that incorporated axial compression and varus/valgus stress, with the patient squatting down in internal and then external rotation (Ege's test). Increased Accuracy of Varus Stress Radiographs Versus Magnetic - PubMed Those that do not include consecutive patients and those that exclude different pathologies may have biased results. McMurrays Test - Physiopedia Measures of efficacy include accuracy, sensitivity, and specificity. Irwig L, Tosteson AN, Gatsonis C, et al. However, if positive findings are grouped with positive findings from other tests, such as joint line tenderness and Apley's test, the test may be more valid. Orthopaedics - A guide for practitioners. One study used a palpable thud and/or pain23, and two studies used a palpable click and/or pain3,20. [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. The anterior portion of the meniscus is not easily tested because the pressure to that part of the meniscus is not as great. https://www.physio-pedia.com/index.php?title=Lateral_Collateral_Ligament_of_the_Knee&oldid=221054, A direct blow to the anteromedial knee and posterolateral corner, 0: Posteriolateral capsule, arcuate-popliteus complex, anterior and posterior cruciate ligaments, lateral gastrocnemius, 20-30: Posteriolateral capsule, arcuate-popliteus complex, iliotibial band, biceps femoris tendon. Of the four studies that demonstrated the highest shifts in probability, only Corea et al4 and Akseki et al3 contained calculable CIs, which were relatively narrow (Table (Table55). Diagnostic accuracy of a new clinical test (the fiessaly Test) for early detection of meniscal tears. 133k Fowler PJ, Lubliner JA. Manzotti A, Baiguini P, Locatelli A, et al. (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. If a study evaluates a test in a very specific group of patients, its findings can only be applied to that same type of cohort. Lateral Collateral Ligament of the Knee - Physiopedia St. Louis, MO: Saunders Elsevier;2008. So, little is known about the validity of this test. Background and Objectives: Clinically, it is beneficial to determine the knee osteoarthritis (OA) subtype that responds well to conservative treatments. Background: Functional hallux limitus (FHL) refers to dorsiflexion hallux mobility limitation when the first metatarsal head is under loading conditions but not in the unloaded state. 2017 Mar;101(Suppl 1):23-35. doi: 10.1007/s12306-017-0460-5. Of the studies evaluated in this review, six used the original description of the McMurray's test4,6,20,2224. Piantanida, A.N. NDkyMTlmYzMyYjdlN2RlZTQ2MjFiMjc5NGRhOWNjYWI3NTliM2NhYzM3YWNj Varus stress radiographs were determined to be more sensitive in diagnosing FCL injuries compared with MRI, with an overall sensitivity of 70% compared with 66%, respectively. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. These authors excluded subjects with clinical or radiographic evidence of arthritis or fracture that would increase the accuracy of testing but decrease the generalizability of the findings. Epub 2018 Jul 17. The most sensitive test used in the diagnostics of medial meniscus lesions was the McMurray test, which showed a sensitivity of 87.5% with 52% specificity. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. Current Orthopaedics. Collectively, these studies indicate that there is little consensus in the reported measures of validity of the McMurray's test and that this is mostly due to limitations in the methodological quality of the studies that were assessed. The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. Anderson and Lipscomb5 compared the McMurray's test to a test termed the Medial-Lateral Grind test that included a varus/valgus component not included in the original McMurray's test. Other signs that have been used to denote a positive test include the production of pain, a clunk, or a pop. This generic search strategy was then combined with a subject-specific strategy (Table (Table1).1). [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn.
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