varus stress test sensitivity and specificity

Likelihood Ratios with confidence: Sample size estimation for diagnostic test results. All abstracts for 44 articles from Medline, 19 articles from CINAhL, 5 articles from AMED, 18 articles from SPORTSDiscus, 548 articles from SCOPUS, and 6 articles from the hand search were reviewed by the authors (Figure (Figure2).2). Those that do not include consecutive patients and those that exclude different pathologies may have biased results. Orthopaedics - A guide for practitioners. Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests. The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. 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. Based on MRI, overall specificity was 68%. Knee Examination: Overview, Periprocedural Care, Technique - Medscape Symptoms related to an intra-articular knee pathology. However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. Clipboard, Search History, and several other advanced features are temporarily unavailable. This is a relatively new tool and has not been subjected to an analysis of its reliability at this time; however, the tool does provide a consistent framework on which to base the analysis of diagnostic studies. Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. Of the studies evaluated in this review, six used the original description of the McMurray's test4,6,20,2224. [5] The LCL further splits the biceps femoris into two parts. The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. A recent evidence-based guideline for the management of acute soft tissue injuries to the knee has recommended that joint line tenderness is the only reliable clinical indicator of meniscal pathology2. Knee Sensitivity and Specificity: Flashcards | Quizlet The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). Knee injuries. The .gov means its official. Evidence. Six of the studies within this review included consecutive patients (Table (Table4).4). 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. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). Before NTc3ODRiOTRjOGU4N2ExOGU2NDEzYWVjZmNiMTQ1N2FjM2U4NjVmMzhlMzRi The low sensitivity figures would indicate that in general, a negative test result is not reliable in ruling out meniscal pathology and a torn meniscus would likely be missed if the McMurray's test was the sole determinant of pathology. Additionally, the single photon-emission CT scan is receiving a lot . N2MzZTc5OGFkMzAwZTZmM2Y1YWFiZTJjMjM3OGNkMmNkM2E4OTYzZWFkMjA5 Sensitivity and specificity values fail to do this11. While some studies have stated that greater clinical experience aids correct diagnosis3,5,19, the only current statistical evidence in this regard shows no difference between an experienced and inexperienced tester 23. Eleven studies met the inclusion criteria. -----BEGIN REPORT----- ZTE1ZTU0YzgxZTBhZGFlNGI5YzcyODQ4YjdhNTE5Yzc0MmMzMTI2YmQ5M2E1 Five studies compared modified versions of the test to McMurray's3,5,6,21,24 (Table (Table33). In one of these studies, the CIs are extremely wide5. Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. Sensitivity figures were higher than specificity for three studies5,20,25 (Table (Table5).5). The sensitivity of diagnosing an FCL injury based on varus stress radiographs was also determined. Be aware of the validity issues surrounding this test. Level II, case-control study. Clinial oriented anatomy. The differences in study populations are likely to have contributed to the wide variability of results across studies. 1st ed. Review of meniscal injury and associated sports. Sensitivity and specificity of this test are only 38% and 41%, respectively. Partial Controlled Early Postoperative Weightbearing Versus Nonweightbearing After Reconstruction of the Fibular (Lateral) Collateral Ligament: A Randomized Controlled Trial and Equivalence Analysis. Arthroscopy has demonstrated an accuracy between 93% and 96%12. Fritz JM, Wainner RS. 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. Obviously, if the test is performed differently and/or the interpretation of a positive test is not the same, the demonstrated accuracy of the test cannot be compared. Fibular collateral ligament and the posterolateral corner. ZDg0M2Q2NDY1ZmIyNjFkZjBiOWE0MzQ3ZjJhZTY1NmRmYTUwYTBiMTNkNTIz Kurosaka M, Yagi M, Yoshiya S, Muratsu H, Mizuno K. Effcacy of the axially loaded pivot shift test for the diagnosis of a meniscal tear. 1173185. Methodology and description of the 11 studies investigating validity and clinical accuracy of McMurray's test for meniscal pathology. 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. OWFmOGE3YWY0OWM1ZWIzOTU5Mjg5Y2I4ODIwZmU1MmQyZWRhMmUxY2ZlMGU3 St. Louis, MO: Saunders Elsevier;2008. This site needs JavaScript to work properly. -----END REPORT-----. Disclaimer. That is usually the journal article where the information was first stated. Were the raters blinded to the results of the other test? 4th ed. Specificity: 100% Valgus Stress Test: Sensitivity: 91% Specificity: 17% Varus Stress Test: Sensitivity: 25-77% Specificity: 98-99% Quadriceps Active Test: Sensitivity: 54-99% Specificity: 97-100% Posterior Sag Test: Inconclusive. They commented that the lack of intertester agreement may have been due to differences in the amount of force produced. ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz This an indication of a LCL tear. 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. Bethesda, MD 20894, Web Policies There are also discrepancies in the studies as to what constitutes a positive McMurray's test. 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). Does the patient have a torn meniscus of ligament of the knee? Sensitivity can be defined as the proportion of patients with the condition who have a positive test result and represents the ability of the test to recognize the condition when present11. The review suggests that modifications of the interpretation of a positive test to include reproduction of pain either as well as or on its own may enhance the validity of the test. Muellner T, Weinstabl R, Schabus R, Vecsei V, Kainberger F. The diagnosis of meniscal tears in athletes: A comparison of clinical and magnetic resonance imaging investigations. ODA1ZGIwMjcwNDYzZDc3OTkwMWYwNWVkMWRlYzk1ZWExOTVhNjBiNWQ2MzUw Increased Accuracy of Varus Stress Radiographs Versus Magnetic - PubMed HHS Vulnerability Disclosure, Help LaPrade RF, DePhillipo NN, Cram TR, Cinque ME, Kennedy MI, Dornan GJ, O'Brien LT. Am J Sports Med. 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. Based on MRI, overall specificity was 68%. The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is unlocked.1. Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. The predictive value of Thve clinical signs in the evaluation of meniscal pathology. So, little is known about the validity of this test. Patient in supine. Epub 2018 Jul 17. . . These studies have hypothesized that by incorporating aspects of varus/valgus stress and/or axial loading into the original McMurray's test, there is an increase in diagnostic value3,5,6. The acute tears frequently result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee.[3]. Consider the findings of this test in conjunction with those of other tests to enhance the likelihood of a correct diagnosis such as joint line tenderness. 8600 Rockville Pike FOIA No valgus or varus stress is applied. The reliability of this test in extension is 68% and in 30 flexion only 56%. Both imaging modalities are recommended to diagnose both acute and chronic FCL injuries. Churchill Livingstone, 2002. Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. The https:// ensures that you are connecting to the A prospective evaluation of a test for lateral meniscal tears. New York: Appleton-Century-Crofts, 1976. 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. Copyright 2018 Arthroscopy Association of North America. Accuracy is the percentage of subjects who are correctly identified as either having or not having a meniscal tear. How to appraise a diagnostic test. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. Valgus and Varus Stress Test [1] Magee DJ. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. official website and that any information you provide is encrypted An official website of the United States government. Malagelada F, Vega J, Golano P, Beynnon B, Ertem F. Knee Anatomy and Biomechanics of the Knee. Comparison of likelihood ratio's for McMurray's test with modified tests. FOIA Future research should concentrate on building a strong methodological base incorporating large samples of consecutive patients with commonly confused pathologies. To evaluate the diagnostic accuracy of magnetic resonance imaging and varus stress radiographs for fibular collateral ligament (FCL) tears, and compare these modalities to intraoperative findings. Sensitivity and specificity values infer the probability of a correct test, given the result of the reference standard11. Pg 791. 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. Varus stress radiographs were determined to be more sensitive in diagnosing FCL injuries compared with MRI, with an overall sensitivity of 70% compared with 66%, respectively. Arthroscopy. MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 Once again, this affects the generalizability of the findings. DOI https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2. Varus Stress Test of the Knee | Lateral Collateral Ligament Test Generated by Wordfence at Mon, 1 May 2023 20:49:59 GMT.Your computer's time: document.write(new Date().toUTCString());. McMurray clearly indicated that the test that bears his name is only relevant for tears in the posterior portion of the cartilage (McMurray, 1942, cited in Corea et al4). Careers, Unable to load your collection due to an error. Please enable it to take advantage of the complete set of features! Anderson AF, Lipscomb AB. Evaluation of knee instability in acute ligamentous injuries. Excluding any with past history of trauma and any with associated fractures, serious arthrosis, previous history of knee surgery or discoid meniscus identified arthroscopically. 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. The Management of Sofi Tissue Knee Injuries: Internal Derangements. NCI CPTC Antibody Characterization Program. YTY1NDM4NjNkYzAwMmMxNGU2MjgwMmMzODFlMTZkZmQyYjRmNTAzM2RkZWY4 The findings of studies testing the validity of the McMurray's test have varied widely, mostly due to variations in the size and type of the study population as well as differences in description and application of the test3. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. Varus Stress Test Purpose: To assess the integrity of the LCL. Selection bias may occur when study subjects are not representative of the population on whom the test is typically applied in practice and can affect the results of a study11. Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. The other hand provides a varus stress to the ankle. . Table Table55 shows the LR+ and LR for the 11 studies included within this review with 95% CIs. M2ZmZDZjMzRlNTA5MjMyYzZkMGVlMDJkNzM3ODllMjM3ODFmYWJhZjAwYzZh Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears. Consider reproduction of pain during the test as a positive test, not just the reproduction of a. A recent literature review on composite testing of the diagnostic tests for the meniscus reported reasonable sensitivity and specificity when the findings of a number of tests are combined31. 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. Federal government websites often end in .gov or .mil. MGY4MmExODg4MDUwZTk2NzUzNjQ0OTMxYjkxN2QwYjQ5MmMxODdmMWU4MDdi I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. J Sport Rehabil. 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. Limits human and English. 2018 May 2;6(5):2325967118770170. doi: 10.1177/2325967118770170. The proportion of people who have the disease or dysfunction who test positive. Oberlander MA, Shalvoy RM, Hughston JC. Clinical Rehabilitation, 22(2), 143-61. Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. Accuracy of 3 Diagnostic Tests for Anterior Cruciate Ligament Tears 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. Enroll in our online course: http://bit.ly/PTMSK DOWNLOAD OUR APP: iPhone/iPad: https://goo.gl/eUuF7w Android: https://goo.gl/3NKzJX GET OUR ASSESSMENT B. Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. YmRhYTcyZWFhNTQ5OTM0YWYwODRjZDU1OWU3ZjBjNmMyMjA4NTcxZTRmMDYw 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). One of the search terms used was McMurray$ test$. . The inclusion of patients with different pathologies would make the results of studies more generalizable to the clinical setting. The proportion of people who test positive and who have the disease or dysfunction. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. 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). Valgus and Varus test of the knee can be graded by the following 1: Grade I: The joint space opening is within 2 mm of the contralateral side. Some studies have attempted to compare the diagnostic value of the McMurray's test to that of modified tests. N2IwYjAxYmE3NzM4ZmE2MTE5MTMyY2Q0M2I3NTQ5YjlkMzU3ODI3ODIyNzg0 Normal elbow range of motion is from 0 at full extension to 140 of flexion, with a range of 30 to 130 required for Valgus instability Valgus instability arises through injuries to the MCL, specifically the AMCL. The agreed quality for each paper is included in Table Table33. In: Campbell's Operative Orthopaedics. Would you like email updates of new search results? The reference lists in review articles were cross-checked and any possibility of name/term variations was queried using MEDLINE and PUBMED. 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. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. 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. Manoeuvres assessing the posterolateral structures include the varus stress test, dial test, the posterolateral drawer, the external rotation recurvatum test, heel height test and the reverse pivot shift. DOI https://doi.org/10.1016/C2009-1-59662-1. Evans PJ, Bell GD, Frank CY. Notes Maximum dorsiflexion locks the subtalar joint and improves the sensitivity of this test. Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. The Journal of Manual & Manipulative Therapy. Although six studies used multiple testers, these did not provide statistics for reliability6,1923. Consecutive patients awaiting elective arthroscopy for suspected meniscal or other conditions based on history and physical examination. Original description. One of the tests was the valgus stress test, particularly at 30 of knee flexion. The same maneuvers are performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the menisci. MR imaging of meniscal cysts: incidence, location, and clinical significance. Clinically, we do not know whether a patient has the condition before the diagnostic test (arthroscopy or MRI) is performed. MDYzNWEzNGQxNDFiMmU0MDBmMmJkZTU4YzNiNzE1MWYxNWM3ZGU1NzFkM2Zm Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. McMurrays Test - Physiopedia Evaluation of Knee Instability in Acute Ligamentous Injuries. Diagnosis and treatment strategies of the multiligament injured knee: a Epub 2017 Feb 14. Each test is repeated with the knee in full extension. Clinical assessment of meniscal pathology in the knee has proven difficult due to the wide number of tests available and variations in their interpretation and application. 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. 269-273). 2019 Jan 21;8(2):e141-e145. Some of the studies did not separate the data for medial from that of lateral meniscal testing5,6,22,25. 1985;13(1):14. The https:// ensures that you are connecting to the Saunders. Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. Sensitivity, specificity, and likelihood ratios (LR) of the McMurray's test with confidence intervals (CI). Malanga GA, Andrus S, Nadler SF, McLean J. Merriman L, Turner W. Assessment of the Lower Limb. The four possible outcomes include true positive, a false positive, a false negative, and a true negative (see Table Table2).2). The objective of this paper was to critically review the literature with respect to the validity and diagnostic accuracy of the traditional McMurray's test and any modifications of this test. Articles may have been missed based on the omission of certain search phrases or the use of a single search phrase as used in this case. Varus stress test video provided by Clinically Relevant, Additional tests for detecting LCL injury with other knee ligaments:[6], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. The MCL and LCL are tested with a valgus and varus stress, respectively, with the knee held at 30 of flexion to isolate the collateral ligaments. Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. Physical examination consisted of general elbow examination and specific examination of the distal biceps based on literature. Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality A recent meta-analysis reports sensitivity and specificity to be 70% and 71%. Similarly, Corea et al4 included consecutive patients who were clinically diagnosed as having torn menisci based on a number of signs and symptoms including locking, a positive McMurray's test, painful clicks, and giving way. official website and that any information you provide is encrypted The technical storage or access that is used exclusively for anonymous statistical purposes. HHS Vulnerability Disclosure, Help

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