Clinical reliability of 6 meniscal tests: a diagnostic accuracy study of 255 patients

Abstract

Background and purpose — We aimed to evaluate the diagnostic accuracy of 6 clinical tests for meniscal tears comparing them with MRI and arthroscopy in a cross-sectional study. Methods — 255 patients (20–45 years) with knee trauma were examined by 2 orthopedic surgeons blinded to the patient’s history, MRI result, and the first clinical examination. The clinical tests (Joint Line Tenderness, McMurray, Apley, Thessaly, Ege, and Hyperflexion) were conducted between 5 and 7 days post-injury (T1) and 4–5 weeks post-injury (T2). Diagnostic accuracy was determined based on MRI and arthroscopic findings, evaluating sensitivity, specificity, and predictive values. Results — Arthroscopy confirmed 188 meniscal tears. The McMurray demonstrated the most balanced performance, with sensitivity of 91% at T1 to 80% at T2 with specificity increase from 55% to 79% showing the highest positive predictive value (PPV) of 92% at T2. Combining McMurray and Apley yielded the best accuracy minimizing false positive. McMurray and Hyper-flexion were more sensitive to medial chondropathy; Thessaly, Ege, and Hyper-flexion were more influenced by anterior knee pain. Conclusion — No single clinical test was sufficiently reliable for independent diagnosis, reinforcing the need for MRI confirmation and further refinement of clinical evaluation strategies.