ACCURACY OF PHYSICAL DIAGNOSTIC TESTS IN MENISCAL TEARS.

Abstract

Purpose of study: The diagnosis of meniscal tears is usually based on the patient’s history and on specific physical tests. Magnetic resonance imaging (MRI) and arthroscopy is often necessary for diagnosis.

Theofilos Karachalios et al. described the new ‘Thessaly test’ and concluded that it could be safely used as a first line screening test for the selection of patients who need arthroscopic meniscal surgery (Ref: J Bone Joint Surg Am. 2005 May; 87(5):955–62). Our objective was to study the role of physical diagnostic tests in screening for meniscal tears and to validate the diagnostic accuracy of the Thessaly test.

Methods & Results: We examined 109 patients [(80 male, 29 female), average age 39.11 years, range (16–66)] who presented with a history suggestive of a meniscal tear. Joint line tenderness,

McMurray’s test and the Thessaly test were assessed by an independent investigator blinded to any imaging data in all patients. MRI and subsequent arthroscopy results were then collated.

Our study showed a much lower diagnostic accuracy for the Thessaly test (61.25 % for medial meniscus and 80 % for lateral meniscus) It is comparable to McMurray’s test (57.14 % for medial meniscus and 77.38 % for lateral meniscus). The Joint line tenderness test has a far superior diagnostic accuracy (80.95 %for medial meniscus and 90.48 % for lateral meniscus). Combining the joint line tenderness test with McMurrays test or the Thessaly test further increased the diagnostic accuracy. Magnetic resonance imaging (MRI) detected 96% of meniscal tears. Arthroscopy was diagnostic and therapeutic in all cases.

Conclusion: Physical tests may not always be diagnostic of meniscal tears. MRI and arthroscopy may be essential in dubious clinical presentations. In our study the Thessaly test in isolation did not have the highest diagnostic accuracy for the detection of meniscal tears but helps increase diagnostic certainty when combined with standard tests.