Line Tenderness and McMurray’s Tests for the Detection of Meniscal Lesions:
What is Their Real Diagnostic Value?

Galli M, Ciriello V, Menghi A, Aulisa
AG, Rabini A & Marzetti E. Archives
of Physical Medicine and Rehabilitation

2013, 94:1126-31.  doi: 10.1016/j.apmr.2012.11.008

Take Home Message:  Joint line tenderness and McMurray’s tests used
together do not necessarily improve meniscal lesion diagnosis. 

Clinical prediction rules, such as the
Ottawa Ankle Rules, improve clinical
care and reduce healthcare costs from unnecessary diagnostic imaging.  Knee meniscal clinical tests may be coupled
together to yield similar results; however, the accuracy of combining meniscal
special tests remains unclear. Therefore, the authors investigated the accuracy
of joint line tenderness (JLT) and the McMurray’s tests in diagnosing meniscal
tears. Three physicians with varying years of experience independently
evaluated 60 patients (~29 years of age)
needing knee arthroscopy.  Separately,
the two tests did not have great sensitivity (JLT: 40-80%, McMurray’s 14-45%)
or specificity (JLT: 20-60%, McMurray’s: 70-80%). In other words, JLT lacked
value in diagnosing meniscal lesions, and McMurray’s was only relatively efficient
at determining when a patient did not have a meniscal lesion (Click here for definitions of Sensitivity & Specificity).  Interestingly, years of experience improved
the accuracy of the McMurray’s test. Furthermore, combining the two clinical
tests did not improve the accuracy of meniscal tear diagnosis beyond what the McMurray’s
test alone could offer.

A set of clinical prediction rules has
yet to be established for the knee; however, the results of this study are still
interesting.  Meniscal tear diagnosis is
relatively accurate when using the McMurray’s test and combining the use of JLT
did not help improve the diagnosis of a meniscal tear.  However, years of experience affected the
overall McMurray’s diagnostic accuracy. 
This demonstrates the importance of practicing and clinical experience.  It would be interesting to see if the
combination of JLT and McMurray’s helped improve diagnosis in a novice or less
experienced clinician.  Also, the authors
used arthroscopy as the gold standard for meniscal lesion diagnosis.  It would be interesting to see how these
tests and others in combination compare to magnetic resonance imaging (MRI)
results as well.  In some cases, clinical
examination may be as good as an MRI.  While combining these two tests does not seem
to improve accuracy and prediction of pathology, there may still be a battery
of tests that would. 

Questions for Discussion: Do
you think that there are other tests that may help (in isolation or
combination) diagnose meniscal tears as part of a clinical prediction rule?  Do you think that MRIs are over used?  Do you think insurances or clinicians would
ever consider surgical recommendations based on clinical examination alone,
without obtaining an MRI?


by: Nicole Cattano
by: Jeffrey Driban

Related Posts:

Galli M, Ciriello V, Menghi A, Aulisa AG, Rabini A, & Marzetti E (2013). Joint Line Tenderness and McMurray Tests for the Detection of Meniscal Lesions: What Is Their Real Diagnostic Value? Archives of Physical Medicine and Rehabilitation, 94 (6), 1126-31 PMID: 23154135