Is There a Role of Weight-Bearing Tests to Diagnose Meniscal Tears?

Abstract

Introduction: Non weight-bearing tests are routinely performed to diagnose meniscal tears, recently it has been suggested that tests performed in weight-bearing can produce higher diagnostic values as they effectively imitate the mechanism of injury to the meniscus by increasing axial load. We prospectively evaluated two non-weight bearing meniscal tests (McMurrays and Joint Line Tenderness), with two weight-bearing tests (Thessalys and Eges). The accuracy, sensitivity and specificity values of these tests were then calculated by correlating with arthroscopy findings. Methods: The four clinical tests were performed on 89 subjects pre-operatively. A positive or negative result was recorded following each clinical test and later compared against the arthroscopy findings post operatively. Results: The weight-bearing tests were overall shown to have a better diagnostic value than non-weight bearing tests. For the medial meniscus, joint line tenderness was the most sensitive test; Eges the most specific, Thessalys had the highest PPV and NPV and was the most accurate. For the lateral meniscus, joint line tenderness was the most sensitive; Mcmurrays the most specific, Thessalys had the highest PPV and NPV and was the most accurate. All four tests were more accurate for medial meniscus compared to lateral. Other pathologies found within the knee were shown to have negative effect on the clinical efficacy of the tests and the highest number of misdiagnoses for meniscal tears occurred with the JLT. Conclusion: This study suggests that the overall clinical ability of the weight-bearing tests to determine the true presence or absence of a Meniscus tear is higher than non-weight-bearing tests.