Comparison of Thessaly Test with Joint Line Tenderness and McMurray Test in the Diagnosis of Meniscal Tears

Magnetic Resonance Imaging Is an Effective First-Line Noninvasive Tool for Meniscal Tear Detection: A Retrospective Comparative Analysis With Knee Arthroscopy

Purpose

To evaluate and compare the diagnostic accuracy of magnetic resonance imaging (MRI) with intraoperative knee arthroscopic findings for identifying or diagnosing meniscal tears.

Methods

We conducted a retrospective study of patients who underwent MRI and knee arthroscopy showing either medial meniscus (MM) or lateral meniscus (LM) tears at a single university hospital. The preoperative MRI findings of patients were compared with intraoperative arthroscopic findings to determine the presence, location, and morphology of meniscal tears. The results of arthroscopy were considered the definitive diagnosis.

Results

A total of 543 patients were initially identified. Of these, 220 met the study eligibility criteria and were included. The sensitivity, specificity, and accuracy of MRI in relation to arthroscopy were 94.29% (95% confidence interval [CI], 89.05%-97.50%), 78.75% (95% CI, 68.17%-87.11%), and 88.64% (95% CI, 83.68%-92.51%), respectively, for MM tears and 76.74% (95% CI, 66.39%-85.18%), 94.03% (95% CI, 88.58%-97.39%), and 87.27% (95% CI, 82.13%-91.37%), respectively, for LM tears. Complex tears were the most common morphology of tears, and the posterior horn was the most common location.

Conclusions

MRI is an effective first-line noninvasive diagnostic tool for investigating meniscal tears, with overall diagnostic accuracies of 88.64% for MM tears and 87.27% for LM tears. MM tears had the highest incidence, particularly in the posterior horn. MRI showed high sensitivity for MM tears, high specificity for LM tears, and substantial agreement with arthroscopy in diagnosing both MM and LM tears. However, MRI's specificity for MM tears and sensitivity for LM tears were lower, suggesting that it may not be as reliable in confirming MM tears or ruling out LM tears.

Level of Evidence

Level III, retrospective cohort study.

Medial joint line tenderness is an indicator for meniscal injuries in dogs

BACKGROUND

Medial meniscal injury is an important aspect of cranial cruciate ligament disease in dogs. This study examines whether caudomedial joint line palpation of the stifle is correlated with medial meniscal injury in canine stifles with concurrent cranial cruciate ligament disease.

METHODS

A total of 91 dogs (97 stifles) presenting with cranial cruciate ligament disease were assessed by palpation of the caudomedial joint line of the affected stifle by a single surgeon. Surgery was then performed to assess for injury to the medial meniscus. The odds of dogs with pain on palpation having a medial meniscal tear were then calculated, with the significance level set at p-value of 0.05.

RESULTS

Dogs showing pain on caudomedial joint palpation had 34.5 times (95% confidence interval 9.7‒125) greater odds of having a medial meniscal tear. Pain on caudomedial joint line palpation had a sensitivity of 0.86, specificity of 0.85, positive predictive value of 0.94, negative predictive value of 0.70 and accuracy of 0.86 for identifying dogs with a medial meniscal tear.

LIMITATIONS

The amount of pressure placed on the caudomedial joint line was not assessed and a control group was not included.

CONCLUSION

Medial joint line tenderness has a significant relationship with medial meniscal tear in dogs with cranial cruciate ligament disease.

Using a combination of three clinical tests for detecting meniscal tears increases the accuracy of the clinical examination

BACKGROUND

Recent studies indicate that using combination of two or more clinical tests for detecting meniscal tear gets a higher sensitivity and specificity than any clinical test performed individually.

METHODS

The study involved 84 participants who were divided into two groups: the "OP group" consisting of participants diagnosed with a meniscal tear and who consequently underwent arthroscopic meniscectomy, and the "CN group" comprising of healthy participants with no history of knee injury. Two independent observers (orthopedic surgeons) recorded the results of six clinical tests: Thessaly Test, joint line tenderness, McMurray Test, Ege Test, Steinmann I Test, and atrophy of the thigh muscles. The tests were grouped into two combinations of three tests each. The first combination included Thessaly Test, joint line tenderness and McMurray Test, while the second combination comprised of remaining three tests. Cochran's Q Test was used to calculate interobserver variability for both combinations of clinical tests and for each test performed individually.

RESULTS

First combination of three clinical tests when considering the combination positive if two tests are positive had high sensitivity of 95%, specificity of 90.9%, and an overall accuracy of 92.9%. Furthermore, when compared to clinical tests performed individually, the combination demonstrated superior results.

CONCLUSIONS

This study shows that using a combination of three clinical tests for detection of meniscal tear (Thessaly Test, joint line tenderness, McMurray Test), when considering the combination positive if two tests are positive, has greater accuracy than six clinical tests performed individually. There were no statistically significant differences between observers.

The Efficacy of the Mulligan Concept to Treat Meniscal Pathology: A Systematic Review

Background

Meniscal pathologies are common knee injuries and arthroscopic surgery is the current accepted gold standard for treatment. However, there is evidence to support the use of the Mulligan Concept (MC) Mobilization with Movement (MWM) for meniscal pathologies including the 'Squeeze' technique, tibial internal rotation (IR), and tibial external rotation (ER).

Hypothesis/Purpose

The purpose of this systematic review was to critically appraise the literature to investigate the effectiveness of MC MWMs for meniscal lesions on patient reported pain, function, and multi-dimensional health status in patients with clinically diagnosed meniscal pathologies.

Study Design

Systematic Review.

Methods

A literature search was completed across multiple databases using combinations of the words "knee, function, mobilization with movement, MWM, mulligan concept, MC, meniscal pathology, meniscal derangement, and meniscal tear." Studies written within the prior 10 years that examined MC MWM techniques to treat knee meniscal injury were included. Articles that met the inclusion criteria (used MC MWM 'Squeeze' technique, tibial IR, or tibial ER for treatment of clinically diagnosed meniscal pathologies; Patient reported outcome [PRO] measures had to be used in the assessment of knee pain or function) were analyzed for quality. Randomized control trials were analyzed using the PEDro scale and the Downs & Black (D&B) checklist, case series were analyzed using the Joanna Briggs Institute (JBI) checklist, and case reports were analyzed using the CARES checklist.

Results

Six articles met the inclusion criteria and were included in this review, two randomized controlled studies, two case series, and two case reports consisting of 72 subjects. All six papers included reports of improvements in pain and function that were either statistically significant or met the minimal clinically important difference (MCID). Five studies reported the Disablement in the Physically Active (DPA) scale that also demonstrated statistically significant differences or met the MCID. The MC MWM 'Squeeze' technique, tibial IR, or tibial ER demonstrated the ability to reduce pain, improve function, and improve patient perceived disability following treatment of a clinically diagnosed meniscal pathology. These studies demonstrated short term results lasting from one week to 21 weeks.

Conclusion

Treatment interventions incorporating MC MWM techniques demonstrated reduction of pain and improvement in function in the short term in patients with clinically diagnosed meniscal pathologies.

Level of Evidence

2a.

A reliability study of a novel visual ischemic palpation scale in an experimental setting

BACKGROUND

Manual palpation is an important part of the clinical examination and generally it has low reliability. The aim of this study was to assess the reliability of a novel method for discriminating 3 different levels of palpation force.

METHODS

This reliability study included 96 healthy physiotherapists and physiotherapy students, who have been taught a new palpation graduated procedure called Visual Ischemic Palpatory Scale (VIPS), aimed to classify the applied pressure based on the finger's ischemia. Force was recorded by a force measurement system putting sensor over a rigid surface. To study the characteristic of VIPS the analysis of variance (ANOVA), Spearman rank correlation coefficient, Intraclass Correlation Coefficient (ICC), Standard Error of Measurements (SEM), and Minimal Detectable Change (MDC) were calculated.

RESULTS

Three distinct degrees were found with distinct forces expression: 1st degree 76.04 g (95% CI 65.86-86.22), 2nd degree 307.87 g (95% CI 263.29-352.44) and 3rd degree 1319.48 g (CI 1204.73-1434.23). Male participants significantly recorded a greater force than females. Good to excellent reliability across degrees were found (0.89 [95% CI: 0.82-0.97]), and final agreement found that more than 65.6% of sample recorded a force in the cut-offs identified. SEM values became bigger as the recorded force increased and MDC were equal to 48.94 g, 188.73 g, and 379.24 g for 1st, 2nd, and 3rd degree, respectively.

CONCLUSIONS

VIPS would appear to have three distinct degrees, sex dependent, with specific force expression for each degree and a good to excellent intra-rater reliability, but a poor agreement between raters.