Validity of the Thessaly test in
evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy

P, Keijesers E, van Geenen RJ, Zijta A, van den Broek M, Verhagen AP, &
Scholten-Peeters GG. J Orthop Sports Phys
Ther.: 1-26.
E pub ahead of print November 24, 2014

Take Home Message: The Thessaly test
is comparable in accuracy to a modified McMurray test in a group of patients
with a high prevalence of meniscal tears. 

The Thessaly test
is a newer test that was designed to assist in the diagnosis of meniscal tears
during clinical examination.  The
Thessaly test is performed by asking a patient to stand with about 20 degrees
of knee flexion and having them internally and externally rotate their body. Since
the introduction of the test in 2005, a couple of studies have investigated it,
but the accuracy of this test has yet to be established.  The authors of this study aimed to evaluate
the diagnostic accuracy of the Thessaly test in comparison to arthroscopy (the
gold standard) in 593 patients (average age = 49 years).  The Thessaly test was performed first,
followed by the more traditional McMurray test, and then the findings were
compared to what a surgeon discovered during arthroscopic surgery.  The Thessaly test had a 64% sensitivity and a
53% specificity where the McMurray test has a 70% sensitivity and a 45%
specificity (see definitions below).  The
authors reported that when combining the two tests, both tests being positive did
not improve the diagnostic accuracy, but that both tests being negative increased
the sensitivity to 82%.      

The overall
accuracy of the Thessaly test is comparable with the McMurray test.  However, clinically there still seems to be a
lack of a relatively accurate test to help rule out or in meniscal
pathology.  This study was done in a
population that had a high prevalence of meniscal injuries, and it would be
interesting to see what the results would be like in a different population.  For example, the Thessaly test was compared with
arthroscopy because it is the gold standard for diagnosing meniscal tears but this
means only surgical candidates were included even though we often evaluate
patients who don’t require an arthroscopy. In the current study examined, the
clinical evaluation was performed by 1 of a 7 experienced physiotherapists
following the same protocol.  The authors
indicated that they did not assess inter-rater reliability, but it would have
been valuable to have multiple physiotherapists perform the same tests, or to
have a more limited range of possible physiotherapists perform the evaluation.  The authors noted that a higher amount of
false positives for the McMurray test may be due to the fact that they used a
modified version of the McMurray test where a positive result was pain and or
clicking.  If the authors of this study
could have looked back at what positive results (pain or clicking) they had,
they may have been able to determine which interpretation of the results helped
to produce better accuracy outcomes. There is still a lot of questions about
using the Thessaly test to diagnose a meniscal tear but the results so far seem
to indicate that we should not rely on it as our only test. Ultimately, the
best approach for a clinician may still be to use a battery of tests in
combination with patient history to most accurately assess during their
clinical examination.    

Questions for
Discussion:  What combination of clinical
tests do you utilize to help to rule out or in a meniscal tear?  Have you used or do you see value in
integrating the Thessaly test in your clinical evaluations?     

Nicole Cattano
by: Jeffrey Driban

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Helpful Information:

Goossens, P., Keijsers, E., van Geenen, R., Zijta, A., van den Broek, M., Verhagen, A., & Scholten-Peeters, G. (2014). Validity of the Thessaly Test in Evaluating Meniscal Tears Compared With Arthroscopy: A Diagnostic Accuracy Study Journal of Orthopaedic & Sports Physical Therapy, 1-26 DOI: 10.2519/jospt.2015.5215