JOINT LINE FULLNESS: CORRELATION OF CLINICAL FINDING WITH PRESENCE OF MENISCAL PATHOLOGY.

Abstract

Purpose: The purpose of our study was to determine sensitivity, specificity and accuracy of the presence of joint line fullness on physical examination in detecting the presence of both meniscal tear and/or cyst as found on MRI and at arthroscopy . Furthermore, we sought to correlate the presence of joint line fullness with type of meniscal tear seen at the time of arthroscopy.

Methods: This was a prospective cohort study, consisting of 100 consecutive patients undergoing knee arthroscopy. Patients who had previous knee surgery or osteophytes on radiographs were excluded. All patients had detailed physical exam documenting the presence of joint line tenderness, joint line fullness and McMurray sign. 61 patients had an MRI preoperatively and therefore it was not a prerequisite to enter the study. MRI was used as the gold standard for determining the presence of a cyst whereas arthroscopy was used as the gold standard for tears. The accuracy, sensitivity, and specificity were calculated and correlated with the type of tear.

Results: Meniscal tears were found in 67 patients at arthroscopy. The accuracy, sensitivity and specificity of joint line fullness (JLF)(73%, 70% and 82% respectively) in detecting meniscal tears was superior to both joint line tenderness (JLT) and McMurray’s test. JLF also obtained the highest positive predictive value of detecting a tear (88%) compare to JLT (77 %)& McMurray’s test (76%). This value was even higher for detecting medial meniscal tear (91%) However, JLF didn’t correlate well with the presence of a cyst with low PPV (29%). Of those patients with joint line fullness on physical exam, (89%) had a horizontal cleavage component at arthroscopy.

Conclusions: Based on the findings of this study, we recommend the routine examination for Joint Line Fullness along with the other common tests to improve the accuracy of clinically diagnosing meniscal tears in particular medial meniscal tear. This may decrease the need for routine MRI for detecting meniscal tears.