KEY POINTS FOR CLINICIANS
* There is little evidence that the diagnosis of meniscal lesions of the knee can be improved by applying the assessment of joint effusion, the McMurray test, joint line tenderness, or the Apley compression test.
* Physicians should be aware of the limited value of those tests.
* The need for applying advanced diagnostic methods or referral for surgical treatment can be based only on the severity of the patient's complaints.
* OBJECTIVE Our systematic review summarizes the evidence about the accuracy of physical diagnostic tests for assessing meniscal lesions of the knee.
* SEARCH STRATEGY We performed a literature search of MEDLINE (1966-1999) and EMBASE (1988-1999) with additional reference tracking.
* SELECTION CRITERIA Articles written in English, French, German, or Dutch that addressed the accuracy of at least one physical diagnostic test for meniscus injury with arthrotomy, arthroscopy, or magnetic resonance imaging as the gold standard were included.
* DATA COLLECTION AND ANALYSIS Two reviewers independently selected studies, assessed the methodologic quality, and abstracted data using a standardized protocol.
* MAIN RESULTS Thirteen studies (of 402) met the inclusion criteria. The results of the index and reference tests were assessed independently (blindly) of each other in only 2 studies, and in all studies verification bias seemed to be present. The study results were highly heterogeneous. The summary receiver operating characteristic curves of the assessment of joint effusion, the McMurray test, and joint line tenderness indicated little discriminative power for these tests. Only the predictive value of a positive McMurmy test was favorable.
* CONCLUSIONS The methodologic quality of studies addressing the diagnostic accuracy of meniscal tests was poor, and the results were highly heterogeneous. The poor characteristics indicate that these tests are of little value for clinical practice.
* KEY WORDS Meta-analysis; diagnosis; physical examination; predictive value of tests; sensitivity and specificity; knee joint; knee injuries; menisci, tibial. (J Fam Pract 2001; 50:938-944)
Various physical diagnostic tests are available to assess meniscal lesions, such as assessment of joint effusion and joint line tenderness (JLT), the McMurray test, and the Apley compression test. (1-4) Many meniscal tests, however, are not easy to perform and seem to be prone to errors. (1,2,4) Also, the diagnostic accuracy of the various meniscal tests has been questioned, (3-5) and conflicting results regarding that accuracy have been reported. (6) Therefore, we systematically reviewed the medical literature to summarize the available evidence about the diagnostic accuracy of physical diagnostic tests for assessing meniscal lesions of the knee and to combine the results of individual studies when possible. We focused on the most common meniscal tests: the assessment of joint effusion, the McMurray test, JLT, and the Apley compression test.
Selection of Studies
We conducted a literature search of MEDLINE (1966-1999) and EMBASE (1988-1999) to identify articles written in English, French, German, or Dutch. The Medical Subject Headings (MESH) terms "knee injuries," "knee joint," "knee," and "menisci tibial," and the text words "knee" and "effusion" were used. The results of this strategy were combined with a validated search strategy for the identification...
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