[Value of the clinical examination in suspected meniscal injuries. A meta-analysis].
BACKGROUND
The physical examination of the knee in cases of suspected meniscal tears serves to increase the probability of a correct diagnosis. Although there is a large variety of functional tests, the quality of each diagnostic test is controversially discussed.


METHODS
Through a systematic literature search in Medline and the Cochrane Database two reviewers independently screened publications, evaluated each study for methodological quality and categorized them into levels of evidence (CEBM). Sensitivity, specificity, positive and negative predicted value, as well as positive and negative likelihood ratio (LR+/LR-) values were calculated in order to render the quality threshold of the physical examination in meniscus impairment.


RESULTS
The Thessaly test (sensitivity: 91%, specificity: 97%, PPV: 97%, NPV: 91% LR+: 31.1, LR-: 0.1) revealed the highest test quality. Limited quality was shown for the Mc Murray test (sensitivity: 51%, specificity: 78%, PPV: 70%, NPV: 61%, LR+: 2.3, LR-: 0.6), "joint line tenderness" (sensitivity: 64%, specificity: 61%, PPV: 62%, NPV: 63%, LR+: 1.6, LR-: 0.6), the Apley-Grinding test (sensitivity: 38%, specificity: 84%, PPV: 71%, NPV: 58%, LR+: 2.4, LR-: 0.7) and the Ege test (sensitivity: 66%, specificity: 86%, PPV: 83%, NPV: 72%, LR+: 4.7, LR-: 0.4). Evidence for Steinman's test, Bragard's test and the meniscal signs of Böhler or Payr could not be tested.


CONCLUSIONS
Meniscal injury can be detected by several functional tests. Using the Thessaly test can improve the physical examination by means of probability of the correct diagnosis, but the results are based on a single study. In patients with ambiguous findings in the physical examination or with suspected combined injury, further diagnostic procedures such as magnetic resonance imaging are necessary to confirm the diagnosis. In clinically certain cases the use of additional diagnostic imaging procedures should be avoided as other authors have shown that with few exceptions this has no influence on the therapy.
Ockert
B
B
Chirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität, Campus Innenstadt, München, Deutschland. Ben.Ockert@aofoundation.org
Haasters
F
F
Polzer
H
H
Grote
S
S
Kessler
M A
MA
Mutschler
W
W
Kanz
K-G
KG
D001182:Arthroscopy / Q000592:standards; D015331:Cohort Studies; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008592:Menisci, Tibial / Q000601:surgery; D010808:Physical Examination / Q000592:standards; D011785:Quality Assurance, Health Care / Q000592:standards; D012015:Reference Standards; D012680:Sensitivity and Specificity; D000070600:Tibial Meniscus Injuries