[Translated article] Accuracy of the Akmese sign as a diagnostic method for posterior root tears of the medial meniscus in Peruvian healthcare facilities.

Abstract

Background Medial meniscus injuries are the most prevalent knee injuries, frequently causing pain, instability, and orthopaedic surgeries. Although several clinical tests are used for meniscal pathology, most were developed for general meniscal lesions rather than specifically for medial meniscus posterior root tears (MMPRT). Evidence on root-specific physical examination signs remains limited. Recently, the Akmese manoeuvre has been introduced as a non-invasive diagnostic tool, assessing pain or tenderness during physical examination. This study aimed to determine the accuracy of the Akmese sign for the clinical diagnosis of MMPRT. Methods This prospective cohort diagnostic study included patients aged 18-55 years scheduled for arthroscopic surgery following a clinical diagnosis of medial meniscus injury between January 2022 and July 2023. Diagnostic performance metrics, including sensitivity, specificity, positive and negative predictive values (PPV, NPV), and likelihood ratios (LR+, LR-), were calculated, using arthroscopy as the reference standard. The interobserver reliability of the Akmese manoeuvre was assessed using the kappa coefficient. Results A total of 201 individuals met the eligibility criteria, with a mean age of 38.4 ± 9.8 years. The Akmese sign was positive in 26 patients, and MMPRT was confirmed by arthroscopy in 28 patients. The Akmese sign demonstrated a sensitivity of 85.7%, specificity of 98.8%, PPV of 92.3%, NPV of 97.7%, LR+ of 74.1, and a LR- of 0.15. Conclusion In this selected surgical population, the Akmese manoeuvre showed promising diagnostic performance and very good interobserver reliability for identifying MMPRT. The sign may be useful as an adjunctive clinical tool to support preoperative suspicion, targeted MRI review, and surgical planning, but it should not be considered a replacement for MRI or arthroscopic assessment.