title: Joint line tenderness and McMurray tests for the detection of meniscal lesions: what is their real diagnostic value?
abstract: OBJECTIVE
  To assess the interobserver concordance of the joint line tenderness (JLT) and McMurray tests, and to determine their diagnostic efficiency for the detection of meniscal lesions.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Orthopedics outpatient clinic, university hospital.
  
  
  METHODS
  Patients (N=60) with suspected nonacute meniscal lesions who underwent knee arthroscopy.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Patients were examined by 3 independent observers with graded levels of experience (>10y, 3y, and 4mo of practice). The interobserver concordance was assessed by Cohen-Fleiss κ statistics. Accuracy, negative and positive predictive values for prevalence 10% to 90%, positive (LR+) and negative (LR-) likelihood ratios, and the Bayesian posttest probability with a positive or negative result were also determined. The diagnostic value of the 2 tests combined was assessed by logistic regression. Arthroscopy was used as the reference test.
  
  
  RESULTS
  No interobserver concordance was determined for the JLT. The McMurray test showed higher interobserver concordance, which improved when judgments by the less experienced examiner were discarded. The whole series studied by the "best" examiner (experienced orthopedist) provided the following values: (1) JLT: sensitivity, 62.9%; specificity, 50%; LR+, 1.26; LR-, .74; (2) McMurray: sensitivity, 34.3%; specificity, 86.4%; LR+, 2.52; LR-, .76. The combination of the 2 tests did not offer advantages over the McMurray alone.
  
  
  CONCLUSIONS
  The JLT alone is of little clinical usefulness. A negative McMurray test does not modify the pretest probability of a meniscal lesion, while a positive result has a fair predictive value. Hence, in a patient with a suspected meniscal lesion, a positive McMurray test indicates that arthroscopy should be performed. In case of a negative result, further examinations, including imaging, are needed.
authors.affiliation: Department of Geriatrics, Neurosciences and Orthopaedics, Teaching Hospital Agostino Gemelli, Catholic University of the Sacred Heart School of Medicine, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Galli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ciriello
authors.forename: Amerigo
authors.initials: A
authors.lastname: Menghi
authors.forename: Angelo G
authors.initials: AG
authors.lastname: Aulisa
authors.forename: Alessia
authors.initials: A
authors.lastname: Rabini
authors.forename: Emanuele
authors.initials: E
authors.lastname: Marzetti
mesh_terms: D000328:Adult; D001182:Arthroscopy; D001499:Bayes Theorem; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008592:Menisci, Tibial / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity