The semilunar cartilages

McMurray, T. P.

doi:10.1002/bjs.18002911612

Cited by 172 publications

(99 citation statements)

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“…29,39 Because only 2 studies 15,24 incorporated this design, subgroup analysis was not attempted. Heterogeneity remained significant among high-quality (QUADAS score of 10 or greater) and low-quality (QUADAS score of less than 10) studies for both the McMurray's 32 and JLT tests. However, for Apley's 4 test, the group of 3 lower-quality studies 18,24,36 showed a P(Q) value of .19, suggesting homogeneity.…”

Section: Subgroup Analysesmentioning

confidence: 95%

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Physical Examination Tests for Assessing a Torn Meniscus in the Knee: A Systematic Review With Meta-analysis

Hegedus¹,

Cook²,

Hasselblad³

et al. 2007

J Orthop Sports Phys Ther

113

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Knee pain has a lifetime prevalence of up to 45% and as many as 31% of individuals with knee pain will consult a general practitioner. 5 Roughly 5% of these individuals will undergo a tibial meniscectomy, 5 and many more will undergo partial meniscectomy or meniscus repair. Surgery of the meniscus is a common orthopedic procedure, constituting 10% to 20% of surgeries performed in some practices. 37 Primary practitioners must make a STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES:To identify, analyze, and synthesize the literature to determine which physical examination tests, if any, accurately diagnose a torn tibial meniscus. BACKGROUND:Knee pain has a lifetime prevalence of up to 45%, and as many as 31% of individuals with knee pain will consult a general practitioner. Roughly 5% of these individuals will undergo a tibial meniscectomy and many more will undergo partial meniscectomy or meniscus repair. Determining which of these individuals is appropriate for surgical consult depends on clinical examination findings. METHODS AND MEASURES:We searched MEDLINE, CINAHL, and SPORTDiscus from1966 to August 2006 and extracted all English-and German-language studies that reported the diagnostic accuracy of individual physical examination tests for a torn meniscus. We retrieved data regarding true positives, false positives, true negatives, and false negatives to create 2-by-2 tables for each article and test. Like tests were then subjected to meta-analysis and subanalysis. Cochran Q test and the I2 statistic were used to examine for the presence of heterogeneity and the extent of the effect of heterogeneity, respectively. A qualitative analysis was also performed using the QUADAS tool. RESULTS:Eighteen studies qualified for the final analyses. Three physical examination tests (McMurray's, Apley's, and joint line tenderness) were examined in more than 7 studies and had enough data to consider meta-analysis. However, study results were heterogeneous. Pooled sensitivity and specificity were 70% and 71% for McMurray's, 60% and 70% for Apley's, and 63% and 77% for joint line tenderness. Large between-study differences could not be explained by prevalence, study quality, or how well an index test was described. CONCLUSIONS:No single physical examination test appears to accurately diagnose a torn tibial meniscus and the value of history plus physical examination is unknown. Differences between studies in diagnostic performance remain unexplained, presumably due to local differences in the way the tests are defined, performed, and interpreted. We recommend a more standardized approach to performing and interpreting these tests and the development of a clinical prediction rule to aid clinicians in the diagnosis of a torn tibial meniscus.

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Section: Subgroup Analysesmentioning

confidence: 95%

“…Data were eligible for pooling in 3 special tests: McMurray's, 32 Apley's, 4 and joint line tenderness (JLT). Raw data from each individual study for these 3 tests was placed in a 2-by-2 table and summarized by the paired statistics sensitivity and specificity.…”

Section: Statistical Analysesmentioning

confidence: 99%

Physical Examination Tests for Assessing a Torn Meniscus in the Knee: A Systematic Review With Meta-analysis

Hegedus¹,

Cook²,

Hasselblad³

et al. 2007

J Orthop Sports Phys Ther

113

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“…Historically it was believed that the menisci served no functional purpose and they were often excised with open total meniscectomy [2] . McMurray [3] described that insufficient removal of the meniscus was the cause of failure of meniscectomy. In 1948 Fairbank [4] reported the clinical outcomes of 107 patients after total meniscectomiesand found that the majority had progressive flattening of the condyle, narrowing of the joint space and ridge formation.…”

Section: Introductionmentioning

confidence: 99%

Treatment of meniscal tears: An evidence based approach

Mordecai

Al-Hadithy

Ware

et al. 2014

WJO

200

164

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Treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g. , age, co-morbidities and compliance) and tear characteristics (e.g. , location of tear/age/reducibility of tear). There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line. Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically. Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g. , nearer the capsular attachment) and horizontal or longitudinal in nature. However, careful patient selection and repair technique is required with good compliance to post-operative rehabilitation, which often consists of bracing and non-weight bearing for 4-6 wk.

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“…This, together with the high cost of MRI, means physical examination tests have a particularly important role to play in the detection of meniscal injuries in clinical practice [5]. Numerous such tests have been developed; however there is on-going controversy regarding their diagnostic value [5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…to the patient's knee during passive knee extension [7]. In contrast the Thessaly Test is a much more recently developed test, first introduced in 2005, and requires the patient to actively rotate his/her knee in standing whilst maintaining either 5° or 20° of knee flexion [8].…”

Section: Introductionmentioning

confidence: 99%