varus stress test sensitivity and specificity

Fowler PJ, Lubliner JA. The inclusion of patients with different pathologies would make the results of studies more generalizable to the clinical setting. In contrast, the paper by Sae-Jung et al24 found sensitivity for medial and lateral menisci of 70% and 68%, respectively, and specificity values for medial and lateral menisci of 60.7% and 47.8%, respectively. NDkyMTlmYzMyYjdlN2RlZTQ2MjFiMjc5NGRhOWNjYWI3NTliM2NhYzM3YWNj ZTE1ZTU0YzgxZTBhZGFlNGI5YzcyODQ4YjdhNTE5Yzc0MmMzMTI2YmQ5M2E1 True positive: the person has the disease and the test is positive. The fibular or lateral collateral ligament (LCL) is a cord-like band and acts as the primary varus stabilizer of the knee. Saunders Elsevier. [11] Sensitivity: 25% . M2NhODMyZGZjNTEwMzAzY2JkMWI0MTUwM2I3NjNjN2RjYmY4NmEyNWE1ZjZk Specificity: not reported. Orthopaedics - A guide for practitioners. The reliability of this test in extension is 68% and in 30 flexion only 56%. Inclusion in an NLM database does not imply endorsement of, or agreement with, A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. Performance: A varus stress test is performed by stabilizing the femur and palpating the lateral joint line. The statistical measures of sensitivity, specificity, and likelihood ratios were calculated from the information provided in the studies. Consequently, it is likely that the accuracy of meniscal testing demonstrated by this study is artificially high compared to studies with a wider inclusion criteria. There is conflicting evidence in the literature over the accuracy of MRI. ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 Changing the threshold to increase sensitivity decreases specificity and vice versa. The therapist applies a varus stress at the knee while the ankle is stabilized. The LCL acts as a secondary stabilizer to anterior and posterior tibial translation when the cruciate ligaments are torn. High sensitivity indicates that a test can be used for excluding a condition when it is negative, but it does not address the value of a positive test. The accuracy of the clinical knee examination documented by arthroscopy: A prospective study. Epub 2017 Feb 14. The proportion of people who do not have the disease or dysfunction who test negative. Epub 2018 Jul 27. With regard to negative likelihood ratios, all but three of the studies demonstrated only a small alteration in probability that a subject with a negative McMurray's test will not have a meniscal tear (Table (Table5).5). A wide variety of clinical tests are used to diagnose meniscal pathology within the knee joint. Bookshelf Patients suspected of having a meniscal tear on the basis of history and mechanism of injury excluding those with multiple injuries, history of knee surgery, early clinical and radiographic signs of osteoarthritis, articular cartilage injuries, neurological and musculoskeletal degenerative disorders, disorders of the synovium, acute injuries (less than 4 weeks post-trauma), and any abnormal findings on conventional radiographs. N2MzZTc5OGFkMzAwZTZmM2Y1YWFiZTJjMjM3OGNkMmNkM2E4OTYzZWFkMjA5 The use of the STARD tool is also a limitation. Rose NE, Gold SM. However, of those that have made this distinction, there is some consensus that the McMurray's test has higher sensitivity with respect to medial meniscal tears and higher specificity with lateral meniscal tears3,4,19,20,24. InAnnales chirurgiae et gynaecologiae 1987 Jan 1 (Vol. The STARD checklist contains 25 items that help to make a judgment about potential bias in the study and appraisal of the applicability of the findings. This trade-off between sensitivity and specificity makes it important that they be considered jointly27. An example of this would be as follows: If the McMurray's test had a LR+ of 9.2 for a particular study, a positive McMurray's test is 9.2 times more likely to occur in patients with a meniscal tear than in those without one29. Generated by Wordfence at Mon, 1 May 2023 20:49:59 GMT.Your computer's time: document.write(new Date().toUTCString());. Anderson AF, Lipscomb AB. Evaluation of knee instability in acute ligamentous injuries. Further, subjects who are positive on the reference standard should reflect a continuum of severity, whereas those who are negative should have conditions commonly confused with meniscal tears17. True negative: the person does not have the disease and the test is negative. As the knee goes into flexion, the LCL loses its significance and influence as a varus-stabilizing structure. NWI4Njg2Y2FiM2QzZGFjNjA2MjRhYTcxMTY2NmVkZmYzNTMwZDdiNTk4YTcy The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. Whiting WC, Zernicke RF. The ligament lies laterally and posteriorly along the joint line. 8600 Rockville Pike Statistical evaluation of McMurray's test in the clinical diagnosis of meniscus injuries. Consecutive patients. The predictive value of Thve clinical signs in the evaluation of meniscal pathology. 2008. However, they only included patients who had had symptoms for at least one year, making extrapolation of their findings to the acute population challenging. MDU1NWE1Nzc5OGVjNTczOGU2OWUyMWYxYmY3Njk5ZTdlMDEwZTQ3MTY0Zjdm Schulzer M. Diagnostic tests: A statistical review. Human Kinetics, 2008. Eleven studies met the inclusion criteria. Results: The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). St. Louis, MO: Saunders Elsevier;2008. Also described a weight-bearing modification of McMurray's (Thessaly test), n/m for McMurray's, but joint line discomfort and possibly a sensation of locking or catching for Thessaly test. While it is difficult to compare results across studies due to the differences in the tests being used, the results of this review appear to show that the modified tests have higher diagnostic value than the McMurray's test. An official website of the United States government. Likelihood Ratio +/-. The review also highlights the idea that modified versions of the test seem to be more valid than the original version. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). https://www.physio-pedia.com/index.php?title=Lateral_Collateral_Ligament_of_the_Knee&oldid=221054, A direct blow to the anteromedial knee and posterolateral corner, 0: Posteriolateral capsule, arcuate-popliteus complex, anterior and posterior cruciate ligaments, lateral gastrocnemius, 20-30: Posteriolateral capsule, arcuate-popliteus complex, iliotibial band, biceps femoris tendon. Value of the physical examination. Oberlander MA, Shalvoy RM, Hughston JC. However, for medial meniscal tears, rates are lower. In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. YWU3NTg0YTg5NzcxMzE4M2I5NjZiYzgxNzlkYjQyNmRjYjE1OWNjZjJmNzVh Akseki et al3 compared the McMurray's test with a weight-bearing version of the McMurray's test that incorporated axial compression and varus/valgus stress, with the patient squatting down in internal and then external rotation (Ege's test). Three of these studies had fairly broad inclusion criteria that better reflect the population seen in clinical practice with two including subjects with suspected meniscal or ligamentous pathology6,19; the study by Sae-jung et al24 included any patients identified as needing arthroscopy. Excluding any with past history of trauma and any with associated fractures, serious arthrosis, previous history of knee surgery or discoid meniscus identified arthroscopically. Sae-Jung S, Jirarattanaphochai K, Benjasil T. KKU knee compression-rotation test for detection of meniscal tears: A comparative study of its diagnostic accuracy with the McMurray test. HHS Vulnerability Disclosure, Help Level of evidence: In most cases Physiopedia articles are a secondary source and so should not be used as references. Fibular collateral ligament and the posterolateral corner. These authors excluded subjects with clinical or radiographic evidence of arthritis or fracture that would increase the accuracy of testing but decrease the generalizability of the findings. The preliminary nature of this tool also means that a more narrative review of the validity and accuracy of the tests has been presented. Sensitivity figures vary from 16%88%, while specificity figures vary from 20%98% (Table (Table5).5). The studies by Akseki et al3, Corea et al4, and Manzotti et al20 revealed negative likelihood ratios that are slightly lower than the other studies. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. Anterior cruciate ligament reconstruction: MR imaging findings. Of the 11 studies identified in this review, nine used arthroscopy as the reference standard, one used MRI, and the remaining study used both MRI and arthroscopy (Table (Table44). There are also discrepancies in the studies as to what constitutes a positive McMurray's test. How likely a positive test result is in people who have the disease or dysfunction as compared to how likely it is in those who do not have the disease or dysfunction. The sensitivity of a test reflects the proportion of people with the disease in question who are tested positive, whereas the specificity is the proportion of those without the disease who are tested negative. This site needs JavaScript to work properly. A recent systematic review reported a diagnostic accuracy between 56 - 84% 5.A prospective cohort study of 213 patients found poor sensitivity for medial and lateral meniscus tears of 48% and 65% respectively 6.Conversely specificity for medial and lateral meniscal tears was high, 94% . Evans et al23 compared a senior examiner with over 10 years experience to a medical student who had recently been taught the technique whereas Karachalios et al21 compared two experienced orthopaedic surgeons with two inexperienced residents. Philadelphia: Wolters Kluwer, 2010. In total, 11 studies have been included in this critical review. Consecutive patients scheduled for menisectomy; acute and chronic. When pooled together using the bivariate random effects model (BREM), the sensitivity value of the 8 studies was 0.2 and the specificity value was 0.88. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Three studies in this review compared the McMurray's test to modified versions that incorporated the added components of varus/valgus stress and axial compression. Mariani et al30 have suggested that the differences in anatomical attachments of the two menisci contribute to these variations in sensitivity and specificity of diagnostic tests30. The agreed quality for each paper is included in Table Table33. 2nd ed. However, this provisional diagnosis was also based on other symptoms that one might consider could be associated with pathologies other than meniscal tears, e.g., pain, recurrent effusion, muscle wasting, and instability. 1987; 76: 269-273. It is important to take this into consideration when analyzing test results of studies that have used more than one examiner. Intertester reliability of clinical judgements of medial knee ligament integrity. Consecutive patients clinically diagnosed as having torn menisci (based on symptoms of pain, locking, painful clicks, recurrent effusions, giving way or signs of extension block, wasting, or instability) Patients with evidence of fracture or arthritis, a previous history of surgery, or with an acute locked knee or haemarthrosis were excluded. Performing the Test: The patient's leg should be relaxed for this test. A control group was composed of patients with an MRI and intact ACL and FCL. 2001;177(2):409413. The differences in study populations are likely to have contributed to the wide variability of results across studies. The sensitivity and specificity of the clinical tests and magnetic resonance (MR) imaging are reviewed because these parameters vary, and an understanding of the diagnostic utility of both the clinical and imaging tests is important in accurately formulating a definitive diagnosis. Patients who underwent arthroscopy to assess suspected meniscal or meniscal together with ACL injuries. In an analysis of 20 available studies, the mean sensitivity and specificity of the anterior drawer test were 38% to 81% in awake patients and 63% to 91% in anesthetized patients, respectively.
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