Description
Objectives:
The aim of this study was to investigate the validity and reliability of the McMurray test and joint line tenderness for diagnosing meniscus and articular cartilage injuries.
Methods:
A retrospective study was carried out with 220 patients who underwent arthroscopic surgery for either or both of meniscus and cartilage injuries between April 2017 and March 2022. Data regarding patient demographics, preoperative assessment including physical examination and imaging, and arthroscopic findings were collected from the medical records. The final diagnosis determined by arthroscopy was compared with age, gender, BMI, and physical examination findings by univariate analysis. Logistic regression analysis was performed to evaluate factors related to injuries. Sensitivity, specificity, and likelihood ratios were calculated for the physical findings that were useful to diagnose meniscus or cartilage injuries. The association between physical examination findings and meniscus tear patterns was also analyzed.
Results:
Of the 235 knees in 220 patients, 111 had an injury involving the menial meniscus (MM), 109 the lateral meniscus (LM), and 130 the articular cartilage. The mean age at surgery was 40.9 years. In univariate analysis, age (p<0.001) and joint line tenderness (p<0.001) were associated with the presence of MM tear. Loss of knee extension (p=0.019), joint line tenderness (p<0.001) and clicks on the McMurray test (p<0.001) were associated with the LM tear. Age (p<0.001), female sex (p=0.017), and joint line tenderness (p=0.004) were associated with the cartilage injuries. In logistic regression analysis, joint line tenderness (OR: 30.6, p<0.001) and clicks on the McMurray test (OR: 2.74, p=0.016) were associated with the LM tear. For the LM tear, joint line tenderness had a sensitivity of 71.6%, specificity of 93.7%, a positive likelihood ratio of 11.3 and a negative likelihood ratio of 0.30, whereas clicks on the McMurray test had 52.1%, 80.5%, 2.68 and 0.59, respectively. In subgroup analysis, a horizontal tear of meniscus was the most common type of injury (n=90), and the sensitivity of the McMurray test tended to be higher for horizontal (83.7%) and complex (84.4%) tears than for other types of tears.
Conclusions:
The joint line tenderness should be used in a standard manner to screen meniscus and cartilage injuries. The McMurray test is useful in diagnosing the LM tear when a click during the test is present, although its usefulness in the diagnosis of MM tear is limited based on the findings of this study.
