Joint Line Fullness and Meniscal Pathology

Abstract

Background:Meniscal tears have been associated with meniscal cysts and fullness of the knee joint line on physical examination.Hypothesis:Joint line fullness is an accurate, sensitive, and specific test to detect meniscal tears.Study Design:Prospective cohort study.Methods:One hundred consecutive patients undergoing knee arthroscopy were included. All had physical examinations documenting the presence of joint line fullness, joint line tenderness, and the McMurray sign. Arthroscopy was the gold standard for tears. Accuracy, sensitivity, and specificity were calculated and correlated with type of tear. Sixty-one patients had a magnetic resonance imaging preoperatively (the gold standard for determining the presence of a cyst).Results:Meniscal tears were found in 67 patients at arthroscopy. The accuracy, sensitivity, and specificity of joint line fullness were, respectively, 73%, 70%, and 82% in detecting meniscal tears; 68%, 87%, and 30% for joint line tenderness; and 47%, 32%, and 78% for the McMurray sign. The highest positive predictive value for detecting a tear was 88% for joint line fullness, compared with 77% for joint line tenderness and 76% for the McMurray sign. However, joint line fullness did not correlate well with the presence of a cyst, with a low positive predictive value (29%). Of those patients with joint line fullness on physical examination, 89% had a horizontal cleavage component of their tear at arthroscopy.Conclusion:Joint line fullness is an accurate, sensitive, and specific test to detect meniscal tears.Clinical Relevance:The findings support the routine use of joint line fullness during physical examination along with other common tests to improve the accuracy of clinically diagnosing meniscal tears.

Effects of rehabilitation approaches for runners with patellofemoral pain: protocol of a randomised clinical trial addressing specific underlying mechanisms

“…To be included, potential participants will have to meet the following inclusion criteria: 1- age between 18 and 45 years; 2- run at least 15 km per week; 3- present a history of anterior knee pain for at least 3 months; 4- report a pain level of at least 3/10 on a visual analog scale during running and during at least three activities among: kneeling, squatting, stairs and resisted knee extension [ 35 ]; and 5- score lower than 85/100 on the Knee Outcome Survey – Activities of Daily Living Scale questionnaire (KOS-ADLS), to ensure a minimum level of symptoms and limitations (clinically important difference of 13.6 points) [ 36 ]. In addition, runners will be excluded if they present one of the following conditions: 1- history of lower limb surgery or patellar dislocation; 2- pain believed to originate either from meniscus [ 37 , 38 ] or from patellar tendon [ 39 ]; 3- pain following an acute trauma; 4- concurrent lower limb injuries; 5- history of neurological, inflammatory or rheumatoid disease. A member of the research team will perform a preliminary screening of the inclusion and exclusion criteria and explain the study during a telephone call.…”

Validez de las maniobras de exploración física para el diagnóstico de la lesión meniscal

“…No obstante, la evidencia que sustenta estos hallazgos no es fuerte 43 . 11,12,21,25,27,31,32,[35][36][37]39,44,46,47,49,50,53,66 f…”

“…El autor comunica una tasa de FN del 44% que junto con un elevado VPN, hacen que la prueba sea muy fiable. Si la prueba se reserva sólo para el menisco interno, entonces su VPP asciende hasta el 91%, y ello la hace altamente predictiva de lesiones del menisco medial 21 .…”

“…Al existir muchas pruebas meniscales descritas, es preciso determinar un uso racional de las mismas y seleccionar las que tienen mayor rentabilidad diagnóstica. Aunque Kelly e Insall proponen la realización de las maniobras de Steinmann, Mc Murray y Apley 8 , analizaremos otras propuestas, que contemplan pruebas publicadas más recientemente, con soporte para analizar su rendimiento 8,[11][12][13][20][21][22]26,27,31,32,34,36,43,44,48,54,56,58 .…”