Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears.
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 degrees of knee flexion, and the Thessaly test at 20 degrees 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 degrees 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 degrees 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 methods.
Karachalios
Theofilos
T
Orthopaedic Department, School of Medicine, Faculty of Health Sciences, University of Thessaly, 22 Papakyriazi Street, Larissa 41222, Hellenic Republic, Greece. kar@med.uth.gr
Hantes
Michael
M
Zibis
Aristides H
AH
Zachos
Vasilios
V
Karantanas
Apostolos H
AH
Malizos
Konstantinos N
KN
D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000503:physiopathology; D007719:Knee Joint / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D000070600:Tibial Meniscus Injuries