varus stress test sensitivity and specificity

ZDFjNGQ5ZTg3MjdkZDAxOTE5MTYxNDQ3NmIzYzNhZjE4ZjAwNDc4M2NiMzEz NCI CPTC Antibody Characterization Program. One of the tests was the valgus stress test, particularly at 30 of knee flexion. They also fail to take into account pre-test probability. Philadelphia: Wolters Kluwer, 2010. 1st ed. 2017 Mar;101(Suppl 1):23-35. doi: 10.1007/s12306-017-0460-5. When refering to evidence in academic writing, you should always try to reference the primary (original) source. The sensitivity of diagnosing an FCL injury based on varus stress radiographs was also determined. Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. Collectively, these studies indicate that there is little consensus in the reported measures of validity of the McMurray's test and that this is mostly due to limitations in the methodological quality of the studies that were assessed. Solomon DH, Simel DL, Bates DW, Katz JN, Schafter JL. ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz Biomechanics of musculoskeletal injury. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Unauthorized use of these marks is strictly prohibited. The Management of Sofi Tissue Knee Injuries: Internal Derangements. An LR+ indicates the degree of certainty that a patient with a positive test actually has the suspected condition while an LR indicates the degree of certainty that a patient with a negative test does not have the suspected condition27. These represent small but sometimes important shifts in probability and the stronger methodology of these studies is reflected by the relatively narrow CIs (Table (Table55). Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. Am J Sports Med. Flow diagram of literature screening process. No valgus or varus stress is applied. Reid MC, Lachs MS, Feinstein AR. Posterior drawer test Posterior sag test (godfrey test) Quadriceps active test Dial test Varus/valgus stress . Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. A control group was composed of patients with an MRI and intact ACL and FCL. and transmitted securely. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. They rated the sensitivity at 25% and could not report any specificity . Based on chronicity of the injuries, MRI was more accurate for detecting acute FCL injuries than chronic injuries (P = .002), and varus stress radiographs were more accurate for detecting chronic FCL injuries than acute injuries (P = .041). Philadelphia: Elsevier, 2016; 2121-2297. These authors also demonstrated that the Medial-Lateral Grind test had smaller (better) LR compared to the McMurray's test although the change in probability was still only small and should be considered rarely important (Table (Table77). In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. Careers. Reverse Pivot Shift Sign of Jakob, Hassler, and Stubli. Because they were investigating this weight-bearing test as well, the authors excluded any patients who presented within six weeks of trauma and those unable to bear weight or unable to squat. The inclusion of patients with different pathologies would make the results of studies more generalizable to the clinical setting. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. Three independent reviewers assessed each of the papers included in the review, and an overall STARD score of methodological quality was determined for each paper. That is usually the journal article where the information was first stated. With a sensitivity of 86% and a specificity of 95%, . ZmZjN2MzNzdhZDFlZWY2OGI0YWExNTViZjA5ZDc3OTA3MTJmYTYyOGFmMGEw MR imaging of meniscal cysts: incidence, location, and clinical significance. The possibility of there being associated intra-articular pathology (such as anterior cruciate ligament rupture) confounds results, and the unknown validity, sensitivity, and specificity of the tests make it difficult for the clinician to be confident in making a definitive diagnosis3. Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. government site. Guidelines for meta-analyses evaluating diagnostic tests. Disclaimer. ZmFjMDhjZmYyOWRiNWU2YjhhMWNhYjFiNTU5YTI5ODM3MTY1ODYwYzc2NmFi M2NhODMyZGZjNTEwMzAzY2JkMWI0MTUwM2I3NjNjN2RjYmY4NmEyNWE1ZjZk 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. The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. MDU1NWE1Nzc5OGVjNTczOGU2OWUyMWYxYmY3Njk5ZTdlMDEwZTQ3MTY0Zjdm [6] When the knee is extended, the LCL is stretched. There are several different reported methods of performing McMurrays Test, Reiders method may be the most accurate[9], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. If a study evaluates a test in a very specific group of patients, its findings can only be applied to that same type of cohort. One of the search terms used was McMurray$ test$. HHS Vulnerability Disclosure, Help Effect of Sectioning of the Anterior Cruciate Ligament and Posterolateral Structures on Lateral Compartment Gapping: A Randomized Biomechanical Study. An LR of 1 indicates that the test result does nothing to change the likelihood that the patient either does or does not have the condition, whereas the higher the LR+, the more certain you can be that a positive test indicates the person has the disorder. [2] Harilainen A et al. In: Campbell's Operative Orthopaedics. [4] The popliteus tendon is deep to the LCL, seperating it from the lateral meniscus. Neuromusculoskeletal examination assessment: A handbook for therapists. The reference lists in review articles were cross-checked and any possibility of name/term variations was queried using MEDLINE and PUBMED. Assessment of the menisci and cruciate ligaments: An audit of clinical practice. The therapist applies a valgus stress at the knee while the ankle is stabilized in slight lateral rotation either with the hand or with the leg held between the examiners arm and trunk. ODFlNzFkZTQ2MDZmOTVkM2Q1MjEzNzY5YTlmZTU2MTRmYWFkYzY2ZmRmNzlj Similarly, sensitivity figures ranged from 27% to 70% across the reviewed papers, generally indicating that a torn meniscus is likely to be missed in many patients; however, specificity figures (2996%) indicating that false positive tests are relatively low and that a positive test makes it likely that the patient actually does have a torn meniscus. The ligament lies laterally and posteriorly along the joint line. YzZhYjViODEyOTFlYzkyIn0= Bhandari M, Guyatt GH. Evaluation of knee instability in acute ligamentous injuries. aAssociate Professor, health & Rehabilitation Research Centre, School of Rehabilitation and Occupation Studies, AUT University, Auckland, New Zealand, bSenior Lecturer, School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand, cHead of School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand, dSchool of Physiotherapy, Auckland University of Technology, Auckland, New Zealand. Knee, McMurray's, Meniscal, Reliability, Sensitivity, Specificity, Testing, Validity. Before If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Evaluation of Knee Instability in Acute Ligamentous Injuries. [4, 6] Thessaly Test. Varus Stress Test [1] Magee DJ. Arthroscopy has demonstrated an accuracy between 93% and 96%12. Careers, Unable to load your collection due to an error. Consecutive patients. Measures of efficacy include accuracy, sensitivity, and specificity. Those that do not include consecutive patients and those that exclude different pathologies may have biased results. MDUwOTJiNWVjMDExNzg5OTRkYzIwNjRlYzdhZmM2MzUyYjUwY2IxYTkzMTRk ZTY2MWNjMWEzNTQ3MTc4OGU3ZWFmY2NhNWFkNDczMWFlOGI3ZDgwMTBkOGFj Positive likelihood ratios presented in the studies reviewed generally indicated small to moderate shifts in probability (0.828.86) in that a positive test will indicate true meniscal pathology although the studies with the highest methodological quality demonstrated likelihood ratios considered to indicate moderate improvements in the probability that this will be the case3,4. 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. Fritz JM, Wainner RS. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. They rated the sensitivity at 25% and could not report any specificity percentage. YmRhYTcyZWFhNTQ5OTM0YWYwODRjZDU1OWU3ZjBjNmMyMjA4NTcxZTRmMDYw As a library, NLM provides access to scientific literature. The sensitivity was 87% for the medial meniscus but only 46% for the lateral meniscus13. Copyright 2018 Arthroscopy Association of North America. These authors considered the overall accuracy of the axially loaded pivot shift test to be higher than that of the McMurray's test (Table (Table7).7). McMurray's test is used to determine the presence of a meniscal tear within the knee. In total, 11 studies have been included in this critical review. Described a modified version (Medial-Lateral Grind test) but no description of McMurray's. The site is secure. Additionally, the single photon-emission CT scan is receiving a lot . Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. The test has therefore often been reported to be of limited value in current clinical practice. Study with Quizlet and memorize flashcards containing terms like Ballottement, Valgus Stress Test, Varus Stress Test and more. This means that tests rarely have both high sensitivity and specificity. YjRkMzE0ZTk0MWM3ZmIzYWU4Mjc2ZTg2NzY5MWVlZTQwNTFlM2VjN2JkOTYy MTk2NGZhNDE4OTk1NmViZWEyZWM3NzcwNDY0NzA4Y2VmMzBjNjI3MjUwNzdj Douglas I, McDermott Meniscal tears. 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). M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm Akseki et al3 included consecutive patients with symptoms related to intra-articular knee pathology although how this was determined was not described. The purpose of this paper was to assess the literature investigating the validity and diagnostic accuracy of the McMurray's test (and modifications) for determining meniscal pathology of the knee so that conclusions could be drawn regarding its clinical usefulness as a test. doi: 10.1016/j.eats.2018.10.007. A guide to the interpretation of likelihood ratio (LR) values. 269-273). NzM3NDQ2NDMzYThiNjlhNjA0M2M3MzVlMWFhYmE5ZDI3ZTI0YTIyZGIyNWM4 FOIA The lower the LR, the more certain you can be that a negative test indicates the person does not have the disorder11 (Table (Table6).6). These authors demonstrated marginally better LR+ but most interestingly, reported that their modified test (the KKU test) was 100% sensitive for lateral meniscal tears indicating that the test can be used for excluding a condition when it is negative. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh 2018 May 2;6(5):2325967118770170. doi: 10.1177/2325967118770170. 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. (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. Review bias may result when the findings of the reference standard test are known by the clinicians performing the diagnostic test. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. 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% . Only one study by Harilainen et al. Described a modified version (Ege's test) but no description of McMurray's. Increased Accuracy of Varus Stress Radiographs Versus Magnetic Resonance Imaging in Diagnosing Fibular Collateral Ligament Grade III Tears. Evans et al23 used consecutive patients on a waiting list for arthroscopy for a variety of conditions including, but not limited to, suspected meniscal tears. ZTU5MGVlOWM4MDcwMGE2YmJiZjNjZTBiMjQ2N2E5OTFmNTliZDgyYzc4ZjQ0 It is primary restraint to varus rotation from 0-30 of knee flexion. Background: Functional hallux limitus (FHL) refers to dorsiflexion hallux mobility limitation when the first metatarsal head is under loading conditions but not in the unloaded state. Studies were included for analysis if they compared the McMurray's test with a gold standard of knee arthroscopy or magnetic resonance imaging (MRI). An official website of the United States government. Baker PE, Peckham AC, Pupparo F, Sanborn JC. However, only Kurosaka et al6 and Evans et al23 made it clear that the examiners were not given any details about the subject's history so that they would not be influenced by this information. The results support the use of both varus stress radiographs and MRI in diagnosing FCL injuries, because MRI is more sensitive in diagnosing an acute FCL tear, and varus stress radiographs are more sensitive in diagnosing a chronic FCL tear. Kane PW, Cinque ME, Moatshe G, Chahla J, DePhillipo NN, Provencher MT, LaPrade RF. Performance: A varus stress test is performed by stabilizing the femur and palpating the lateral joint line. These comments are also supported by the findings of a recent meta-analysis carried out by Hegedus et al7 and Meserve et al8. Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests. NjZjMWViMWE5MzNlMDFhOTA3YzAwYzUzODYzZmQyZGI2ODk1ZmJlOGM4YzZh . YzM5MWNkYzMyMjQ0ZmU4MDdjZjg2NzYxZjhlMGI2N2RmMGI3ODExOWFmMDdl Medline and CINAHL search strategy via OVID. Sensitivity figures vary from 16%88%, while specificity figures vary from 20%98% (Table (Table5).5). 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. [5], The LCL stabilizes the lateral side of the knee joint, mainly in varus stress and posterolateral rotation of the tibia relative to the femur. Table Table55 shows the LR+ and LR for the 11 studies included within this review with 95% CIs. 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. The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is unlocked.1. Likelihood Ratios with confidence: Sample size estimation for diagnostic test results. During the maneuver, the joint line is palpated both medially and laterally. When refering to evidence in academic writing, you should always try to reference the primary (original) source. The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur. Based on MRI, overall specificity was 68%. Consecutive patients with knee pain of at least one year's duration that warranted arthroscopic investigation. Although these authors mentioned that the examiners were blinded to the results of the MRI, they did not make it clear if the examiners knew that there were a similar number of normals and symptomatic subjects included in the study or if they knew which group each individual subject belonged to. 5, pp. . Analysis of the quality of studies that evaluate the validity and accuracy of tests, such as the McMurray's test, is difficult if key information regarding the design, conduct, and analysis of the study are not reported by the authors9. Clinial oriented anatomy. 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. [2] Harilainen A. Orthopedic Physical Assessment: 5 th Edition. Authors of 9 studies examined the Lachman test and reported sensitivity values ranging from 0.63-0.93 and specificity values ranging from 0.55-0.99. sharing sensitive information, make sure youre on a federal Check for excessive gapping and if you can reproduce the patients pain. Consecutive patients awaiting elective arthroscopy for suspected meniscal or other conditions based on history and physical examination. 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). Saunders. We hypothesized that valgus arthritic knees would respond better to conservative treatment than varus . ZDZkZjczMGZkNzQ1OWMxZTQyNDY2ZTAzYTM5OTk2ZmQ1YjkzNDFjMDhmNzMy Evans et al23 concluded that examiner experience had little effect on the accuracy of the diagnosis; however, they noted that the student examiner demonstrated a significant association (p = 0.002) between the diagnosis of a medial meniscus tear and reproduction of a medial thud, while the experienced examiner demonstrated a significant association between this diagnosis and the reproduction of pain (p = 0.008) or a medial sensation (p = 0.001). Am J Roentgenol. When confidence intervals are not present, the CIs were incalculable due to absence of raw data. The final two studies20,21 limited their study population to patients suspected of meniscal injury. A recent study by Winters and Tregonning13 showed a diagnostic accuracy for MRI to be 90% for the medial meniscus and 82% for the lateral meniscus. 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. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi Noble J, Erat K. In defence of the meniscus: A prospective study of 200 menisectomy patients. Changing the threshold to increase sensitivity decreases specificity and vice versa. eyJtZXNzYWdlIjoiMDAzMWIwNTU1ZDk0ZjIzMGU1NDkwYzhmOWYxZTk0YWI3 how likely a negative 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. Operational definitions of diagnostic accuracy terms used in the studies investigating validity of McMurray's test for meniscal pathology (modified from Powell & huijbregts10). Blinding of the clinicians from the results of the diagnostic test was either not mentioned or not performed in all of the studies in this review except for the study by Karachalios et al21. This is not surprising given the complicated nature of the technique and the difficulty in controlling the amount and direction of forces across testers. MGY4MmExODg4MDUwZTk2NzUzNjQ0OTMxYjkxN2QwYjQ5MmMxODdmMWU4MDdi Whenever suspecting a posterolateral complex injury, one has to carefully perform a valgus stress test in 0 degrees and 30 degrees. eCollection 2022 Jun. 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. All patients who underwent an isolated FCL or combined anterior cruciate ligament (ACL)/FCL reconstruction by a single surgeon between 2010 and 2017 with preoperative varus stress radiographs and magnetic resonance imaging (MRI) were included in this study. sharing sensitive information, make sure youre on a federal [5] The LCL further splits the biceps femoris into two parts. Sensitivity is the probability of a positive test result in someone with the pathology, whereas specificity is the probability of a negative test result in someone without the pathology.6Traditionally, tests which have high sensitivity values are able to correctly identify individuals with the pathology; thus, if the examiner obtains a negative Referred from GP/A&E with suspected cruciate ligament or meniscal pathology. Ciba M, Winkelmeyer EM, Schock J, Westfechtel S, Nolte T, Knobe M, Prescher A, Kuhl C, Truhn D, Nebelung S. Sci Rep. 2022 Jul 13;12(1):11858. doi: 10.1038/s41598-022-15787-2. This, along with the conclusions discussed above, suggests that the McMurray's test should be used as one of a combination of tests in the clinical setting3,22,23. Results: Anderson and Lipscomb5 used consecutive patients who were suspected of having a meniscal tear; however, these authors excluded subjects who had associated ligamentous injuries (as demonstrated by arthroscopy) from the statistical analysis. Malanga GA, Andrus S, Nadler SF, McLean J. Merriman L, Turner W. Assessment of the Lower Limb. A prospective study comparing the accuracy of the clinical diagnosis of meniscal tears with magnetic resonance imaging and its effect on clinical outcome. Arthrosc Tech. Yedlinsky, N.T. Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. These findings are contrasted by those of Karachalios et al21, who reported a 95% agreement for both intra- and intertester reliability for all of the clinical tests they employed. MRI has also shown to be highly reliable, but due to its expensive cost, they are less frequently used. 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. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. Schulzer M. Diagnostic tests: A statistical review. Generally, the McMurray's test has relatively high specificity and low sensitivity. The anterior portion of the meniscus is not easily tested because the pressure to that part of the meniscus is not as great. 1985;13(1):14. High specificity indicates that a test can be used for including a condition when it is positive26. Federal government websites often end in .gov or .mil. Address all correspondence and requests for reprints to: Wayne Hing. This trade-off between sensitivity and specificity makes it important that they be considered jointly27. The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.

Old Ursuline Convent Wedding Cost, Articles V