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Systematic review
Special tests for assessing meniscal tears within the knee: a systematic review and meta-analysis
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  1. Benjamin E Smith1,
  2. Damian Thacker2,
  3. Ali Crewesmith1,
  4. Michelle Hall3
  1. 1Department of Physiotherapy Outpatients, London Road Community Hospital, Derby Hospitals NHS Foundation Trust, Derby, UK
  2. 2Department of Physiotherapy Outpatients, Ashfield Health Village, Kirkby-In-Ashfield, Nottingham, UK
  3. 3School of Health Sciences, Clinical Sciences Building, University of Nottingham, Nottingham, UK
  1. Correspondence to Benjamin E Smith
    , Department of Physiotherapy Outpatients, London Road Community Hospital, Derby Hospitals NHS Foundation Trust, London Road, Derby DE1 2QY, UK; benjamin.smith3{at}nhs.net

Extract

Background Musculoskeletal knee pain is a large and costly problem, and meniscal tears make up a large proportion of diagnoses. ‘Special tests’ to diagnose torn menisci are often used in the physical examination of the knee joint. A large number of publications within the literature have investigated the diagnostic accuracy of these tests, yet despite the wealth of research their diagnostic accuracy remains unclear.

Aim To synthesise the most current literature on the diagnostic accuracy of special tests for meniscal tears of the knee in adults.

Method An electronic search of MEDLINE, Cumulative Index to Nursing and Allies Health Literature (CINAHL), The Allied and Complementary Medicine Database (AMED) and SPORTDiscus databases was carried out from inception to December 2014. Two authors independently selected studies and independently extracted data. Methodological quality was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) 2 tool.

Results Nine studies were included (n=1234) and three special tests were included in the meta-analysis. The methodological quality of the included studies was generally poor. McMurray's had a sensitivity of 61% (95% CI 45% to 74%) and a specificity of 84% (95% CI 69% to 92%). Joint line tenderness had a sensitivity of 83% (95% CI 73% to 90%) and a specificity of 83% (95% CI 61% to 94%). Thessaly 20° had a sensitivity of 75% (95% CI 53% to 89%) and a specificity of 87% (95% CI 65% to 96%).

Conclusions The accuracy of the special tests to diagnose meniscal tears remains poor. However, these results should be used with caution, due to the poor quality and low numbers of included studies and high levels of heterogeneity.

Acknowledgments

The authors are grateful to Arthritis Research UK and the Chartered Society of Physiotherapy Charitable Trust for providing the funding for BES to complete this study.

https://doi.org/10.1136/ebmed-2014-110160

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    Extract

    Background Musculoskeletal knee pain is a large and costly problem, and meniscal tears make up a large proportion of diagnoses. ‘Special tests’ to diagnose torn menisci are often used in the physical examination of the knee joint. A large number of publications within the literature have investigated the diagnostic accuracy of these tests, yet despite the wealth of research their diagnostic accuracy remains unclear.

    Aim To synthesise the most current literature on the diagnostic accuracy of special tests for meniscal tears of the knee in adults.

    Method An electronic search of MEDLINE, Cumulative Index to Nursing and Allies Health Literature (CINAHL), The Allied and Complementary Medicine Database (AMED) and SPORTDiscus databases was carried out from inception to December 2014. Two authors independently selected studies and independently extracted data. Methodological quality was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) 2 tool.

    Results Nine studies were included (n=1234) and three special tests were included in the meta-analysis. The methodological quality of the included studies was generally poor. McMurray's had a sensitivity of 61% (95% CI 45% to 74%) and a specificity of 84% (95% CI 69% to 92%). Joint line tenderness had a sensitivity of 83% (95% CI 73% to 90%) and a specificity of 83% (95% CI 61% to 94%). Thessaly 20° had a sensitivity of 75% (95% CI 53% to 89%) and a specificity of 87% (95% CI 65% to 96%).

    Conclusions The accuracy of the special tests to diagnose meniscal tears remains poor. However, these results should be used with caution, due to the poor quality and low numbers of included studies and high levels of heterogeneity.

    Acknowledgments

    The authors are grateful to Arthritis Research UK and the Chartered Society of Physiotherapy Charitable Trust for providing the funding for BES to complete this study.

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    Footnotes

    • Twitter Follow Benjamin Smith at @benedsmith

    • Contributors BES was responsible for conception and design, publication screening, acquisition of data, analysis and interpretation, as well as drafting and revising the manuscript. DT was responsible for publication screening, analysis, reviewing and revising the manuscript. AC was responsible for acquisition of data, as well as reviewing and revising the manuscript. MH was responsible for reviewing and revising the manuscript. All authors have read and approved the final manuscript.

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.