varus stress test sensitivity and specificityvarus stress test sensitivity and specificity

Kennedy MI, Akamefula R, DePhillipo NN, Logan CA, Peebles L, LaPrade RF. Diagnosis and treatment strategies of the multiligament injured knee: a This is not surprising given the complicated nature of the technique and the difficulty in controlling the amount and direction of forces across testers. Schulzer M. Diagnostic tests: A statistical review. Of the studies evaluated in this review, six used the original description of the McMurray's test4,6,20,2224. 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. Be aware of the validity issues surrounding this test. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). 8600 Rockville Pike and transmitted securely. These authors suggested that this increase in sensitivity and specificity compared to previous studies was due to their broader definition of a positive test, i.e., reproduction of a click or pain3; however, this does not explain the similar findings of Corea et al4 in which only a click was indicative of a positive test. 1st ed. This an indication of a LCL tear. 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. Careers, Unable to load your collection due to an error. Some of the studies did not separate the data for medial from that of lateral meniscal testing5,6,22,25. The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur. 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. The proportion of people who test positive and who have the disease or dysfunction. Excluding any with past history of trauma and any with associated fractures, serious arthrosis, previous history of knee surgery or discoid meniscus identified arthroscopically. [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. A recent meta-analysis illustrates the difference in test characteristics when performed on patients under anesthesia. This review identified that the McMurray's test is of limited clinical value due to relatively low sensitivity, with modified tests (associated with the traditional McMurray's test) having higher diagnostic accuracy and thus these may be more useful clinically. 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. Generally, the McMurray's test has relatively high specificity and low sensitivity. 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. eCollection 2022 Jun. Sensitivity & Specificity Sensitivity: 66 % Specificity: 60 % A study on 21 patients referred with chronic medial collateral ligament injuries, the Valgus stress test at 30, 60, 70, or 90 degrees of elbow flexion was performed (The Reference Standard was Surgical visualization ). PMC Arthroscopy. The Medial-Lateral Grind test had a higher LR+ (Table (Table7)7) when compared to the McMurray's test; however, its CIs were extremely wide, bringing into question the precision of this estimate of reliability (Table (Table7).7). Before The description of a test within a study should be sufficient to enable replication of the test by practitioners and subsequent researchers. Orthopaedics - A guide for practitioners. Take the leg and bring it in 30 Flexion (MLPP) and use a cushion or edge of the bed so the patient can relax. The preliminary nature of this tool also means that a more narrative review of the validity and accuracy of the tests has been presented. These comments are also supported by the findings of a recent meta-analysis carried out by Hegedus et al7 and Meserve et al8. The sensitivity and specificity of the McMurray's test reported in the studies identified in this review vary widely (Table (Table5).5). Unauthorized use of these marks is strictly prohibited. ZDFjNGQ5ZTg3MjdkZDAxOTE5MTYxNDQ3NmIzYzNhZjE4ZjAwNDc4M2NiMzEz At the proximal level this ligament is closely related to the joint capsule, without having direct contact, as it is separated by fat pad, The insertion is augmented by the iliotibial band. 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. The proportion of people who test negative and who do not have the disease or dysfunction. M2ZmZDZjMzRlNTA5MjMyYzZkMGVlMDJkNzM3ODllMjM3ODFmYWJhZjAwYzZh 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. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 Agreement regarding which articles to read in full was determined by consensus. 2008. The external validity of a study is largely dependent on the study population. How to appraise a diagnostic test. Examining diagnostic tests: An evidence-based perspective. 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. Although six studies used multiple testers, these did not provide statistics for reliability6,1923. Common terms. YjQ3NDViZGE1YWVjODEwNTIzYzIyMmY1YjViMDhhNGI3Y2YyNTI4NmMwMjli -----BEGIN REPORT----- 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. As previously documented in the literature10, the definition and calculation of statistical measures of concurrent criterion-validity are based on the absence or agreement between the clinical test and the gold standard test. Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality[7] A recent meta-analysis reports sensitivity and specificity to be 70% and 71%. However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz 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. ZDg0M2Q2NDY1ZmIyNjFkZjBiOWE0MzQ3ZjJhZTY1NmRmYTUwYTBiMTNkNTIz Fowler and Lubliner22 attributed their low sensitivity results (compared to previous studies)5,25 to population differences between the studies (Table (Table5).5). However, for medial meniscal tears, rates are lower. More recent research has shown that modifications to the original McMurray's test may have better validity and diagnostic accuracy than the original McMurray's test3,58. The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. 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%. In: Campbell's Operative Orthopaedics. Differences in the type of tear have been suggested as influencing the result of clinical tests; however, no detailed investigation of this issue exists in the current literature3. ODA3OTUwYWUyMzM0ODhjYWM2MzMzZDc4YTcxNWI4Njc5NDlmMTE2NjIxOTc0 Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Canada. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Arthroscopy has demonstrated an accuracy between 93% and 96%12. YzA0Nzk1ZjQxYjY5Mzg4MWUwNDRlODM0NDRiNzZiM2I4OWVhNTQ1YmVlMDNj Specificity: the ability of a test to correctly identify people without the disease. 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). followers, 712k Varus Stress Test - The Student Physical Therapist 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. Likelihood Ratios with confidence: Sample size estimation for diagnostic test results. (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. Current Orthopaedics. 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). 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. Notes Maximum dorsiflexion locks the subtalar joint and improves the sensitivity of this test. Level of evidence: Clipboard, Search History, and several other advanced features are temporarily unavailable. The Diagnostic Accuracy of Clinical Tests for Stress Fractures Orthopedic Physical Assessment: 5 th Edition. The importance of the valgus stress test in the diagnosis of - PubMed Effect of Sectioning of the Anterior Cruciate Ligament and Posterolateral Structures on Lateral Compartment Gapping: A Randomized Biomechanical Study. 13th ed. 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. This lack of consensus in the literature highlights the risk that the criteria indicating a positive test can influence the test outcome, irrespective of whether the test was performed in the same manner on the same patient. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt. 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. A total of 232 patients were included: 98 patients in the FCL tear group (mean age: 33.6 12.2 years) and 134 patients in the control group (mean age: 44.0 17.2 years). The Valgus Test of the knee is performed with the patient lies in the supine position. Knee Special Tests (Specificity & Sensitivity) Flashcards Limits human and English. The site is secure. M2NhODMyZGZjNTEwMzAzY2JkMWI0MTUwM2I3NjNjN2RjYmY4NmEyNWE1ZjZk Fowler PJ, Lubliner JA. Saunders Elsevier. 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. A prospective study comparing the accuracy of the clinical diagnosis of meniscal tears with magnetic resonance imaging and its effect on clinical outcome. There is conflicting evidence in the literature over the accuracy of MRI. Sensitivity figures were higher than specificity for three studies5,20,25 (Table (Table5).5). Changing the threshold to increase sensitivity decreases specificity and vice versa. MDU1NWE1Nzc5OGVjNTczOGU2OWUyMWYxYmY3Njk5ZTdlMDEwZTQ3MTY0Zjdm Sensitivity: the ability of a test to correctly identify patients with a disease. Although blinding was not mentioned in respect to the other studies, the majority required the clinical examination to be performed prior to the diagnostic arthroscopy, suggesting that the examiner would indeed be blinded to the results of the diagnostic test. Patients who underwent arthroscopy to assess suspected meniscal or meniscal together with ACL injuries. Patients diagnosed with meniscal lesions (based on symptoms including pain, recurrent edema, giving way, joint clicks, or block to movement) having arthroscopic surgery. Varus Stress Test [1] Magee DJ. The assessment results for methodological quality has been presented under the following headings: the STARD analysis, reference standard, population differences, blinding, description and interpretation of test, inter-tester reliability, diagnostic accuracy and validity, sensitivity and specificity, likelihood ratios, and McMurray's test compared to modified versions of the test. 76, No. TP=true positive, FP=false positive, FN=false negative, TN=true negative. ZTU5MGVlOWM4MDcwMGE2YmJiZjNjZTBiMjQ2N2E5OTFmNTliZDgyYzc4ZjQ0 Sensitivity: 25%. Knee, McMurray's, Meniscal, Reliability, Sensitivity, Specificity, Testing, Validity. The reliability of this test in extension is 68% and in 30 flexion only 56%. M2MwN2QyM2QzMGFjZjQ3MDgzMGRiYzAyMmRlZDc3MTAxODc4MDdhNzcyZWMz Ann Chir Gynaecol. 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. Acute patients (< 6 weeks) excluded. DOI https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2. The ligament lies laterally and posteriorly along the joint line. 2017 Dec;33(12):2177-2181. doi: 10.1016/j.arthro.2017.06.028. Studies were also not examined where they clearly did not meet the search criteria. It is primary restraint to varus rotation from 0-30 of knee flexion. This site needs JavaScript to work properly. 2nd ed. Irwig L, Tosteson AN, Gatsonis C, et al. The differences in study populations are likely to have contributed to the wide variability of results across studies. Whiting WC, Zernicke RF. Symptoms related to an intra-articular knee pathology. 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. Relatively narrow confidence intervals also attest to the reliability of these two studies3,4 (Table (Table55). Does the patient have a torn meniscus of ligament of the knee? Clinically, we do not know whether a patient has the condition before the diagnostic test (arthroscopy or MRI) is performed. The reference lists in review articles were cross-checked and any possibility of name/term variations was queried using MEDLINE and PUBMED. Accessibility Physical examination tests for assessing a torn meniscus in the knee: A systematic review with meta-analysis. YzFjZGMyZmVmOTJjNWQ2NWYyNDVkNDE1OWM3Yzg5NjE2MWNhYTY1ZGZlNGYw Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. How to Perform Varus Stress Test Position of Patient: The patient should be relaxed in the supine position. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. Further, the description of the test itself should be well explained, and improving intertester reliability in the future would increase the validity of the studies. MWU3NjBlM2FlMDU2YWM3ODA4ZGIyZTNjODFkOWU2ZDBkMGNiYzRhZjE2MGRk In: DeLee & Drez's Orthopaedic Sports Medicine. 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. Studies looking at diagnostic accuracy, sensitivity and specificity have demonstrated varied values. 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). Am J Roentgenol. Level II, case-control study. In general, sensitivity figures are much lower than specificity and the CI limits are wider. I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). Posterior drawer test Posterior sag test (godfrey test) Quadriceps active test Dial test Varus/valgus stress . 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. Anterior cruciate ligament reconstruction: MR imaging findings. Describes clinical information available to raters, Describes statistical methods for comparing diagnostic accuracy and expressing uncertainty, Describes methods for calculating test reproducibility; if done, Reports when study was done with start and end dates for recruitment, Reports clinical and demographic characteristics of subjects, Reports how many subjects satisfying inclusion criteria did not undergo the tests; describes why these subjects were not tested, Reports time interval between researched and reference test and any treatment provided in between tests, Reports disease severity in subjects with target condition and other diagnoses in subjects without target condition, Reports cross-tabulation of researched and reference test, Reports adverse effects from researched and reference test, Reports estimates of diagnostic accuracy and measures of statistical uncertainty, Reports how indeterminate test results, missing responses, and outliers of researched test were handled, Reports estimates of variability between raters, centers, or subject subgroups; if done, Reports estimates of test reproducibility; if done, Discusses clinical applicability of study findings. Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. 4th ed. MRI has also shown to be highly reliable, but due to its expensive cost, they are less frequently used. Described a modified version (Ege's test) but no description of McMurray's. Each test is repeated with the knee in full extension. Unlike the medial meniscus, which is attached to the medial ligament, the lateral meniscus is not attached to the lateral ligament. 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. If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. Epub 2018 Jul 27. Kurosaka et al6 stated that diagnostic accuracy is lessened in patients with multiple pathologies, whereas Akseki et al3 found that there was no reduction in diagnostic accuracy with an associated tear of the ACL. YzZhYjViODEyOTFlYzkyIn0= Biomechanics of musculoskeletal injury. 269-273). [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. One study used a palpable thud and/or pain23, and two studies used a palpable click and/or pain3,20. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. Human Kinetics, 2008. Clinical diagnosis of meniscal tears: Description of a new manipulative test. Likelihood Ratio +/-. Each of these studies demonstrated improved diagnostic accuracy of these modified tests compared to the original McMurray's; however, they concluded that the modified tests should be used as well, as rather than as an alternative to other diagnostic tests3,5,6. Malagelada F, Vega J, Golano P, Beynnon B, Ertem F. Knee Anatomy and Biomechanics of the Knee. In extension, the posterior capsule and cruciate ligaments act as secondary restraints for varus stress. Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. 24 General examination included carrying angle (normal, valgus,. Original description. ZmZjN2MzNzdhZDFlZWY2OGI0YWExNTViZjA5ZDc3OTA3MTJmYTYyOGFmMGEw Test Position: Supine. That is usually the journal article where the information was first stated. 5, pp. MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi Performing the Test: The patient's leg should be relaxed for this test. 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. 8600 Rockville Pike Evans et al23 demonstrated a low level of agreement between the two examiners with intertester agreements ranging from poor for reproduction of a medial sensation (Kappa = 0.10) to fair (K = +0.38) for lateral pain. any of these symptoms can indicate a compromised medial or lateral meniscus. Specificity: not reported. Other studies3,5,19 commented that greater clinical experience may affect the results of the test but they did not provide any statistical evidence to support this assertion. Bhandari M, Guyatt GH. = (Number of TP + Number of TN)/(Numbers of TP + FP + FN), Identifies article as a study of diagnostic accuracy, Describes study population (inclusion criteria, exclusion criteria, settings, locations), Describes data collection (prospective or respective), Describes reference standard and rationale, Describes technical Specifications of material and methods involved, Describes definition and rationale of units, cut-of points, or categories of results of tests, Describes number, training, and expertise of raters. The remaining studies do not clearly state if their subjects were consecutive. M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm 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. Acute knee injuries: use of decision rules for selective radiograph ordering. The use of the STARD tool is also a limitation. This is true in the case of the study by Akseki et al3 but not for the study by Evans et al23 (Tables (Tables44 and and55). If you believe Wordfence should be allowing you access to this site, please let them know using the steps below so they can investigate why this is happening. OThmMmM0YTcwMmQwODZhZWFkYzNjNzRlOTkzZiIsInNpZ25hdHVyZSI6IjVh 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. Acute injuries excluded. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. 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. Consecutive patients with knee pain of at least one year's duration that warranted arthroscopic investigation. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. Three studies in this review compared the McMurray's test to modified versions that incorporated the added components of varus/valgus stress and axial compression. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Houten: Bohn Stafleu Van Loghum, 2005. 2018 Nov 1;27(6):596-600. doi: 10.1123/jsr.2016-0188. Moore KL, Dalley AF, Agur AMR. [4, 6] Thessaly Test. The technical storage or access that is used exclusively for anonymous statistical purposes. Therefore, articles were assessed using the STARD (Standards for Reporting of Diagnostic Accuracy) checklist of methodological quality9, which uses established criteria for quality assessment of different research formats10. NTcwOGRhYWNmMWQyOTg0NjE1M2QwNTU5MTk0Nzk2OTQzMGU3YmUxODlhZjM0 Referred from GP/A&E with suspected cruciate ligament or meniscal pathology. All had persistent symptoms at least 8 weeks post-injury. Fibular Collateral Ligament Reconstruction in Adolescent Patients. Clinical Rehabilitation, 22(2), 143-61. The best statistics for summarizing usefulness of a diagnostic test appear to be likelihood ratios (LR)17. the contents by NLM or the National Institutes of Health. The majority of studies did not report intertester or intratester reliability of the McMurray's test. 2017 Mar;101(Suppl 1):23-35. doi: 10.1007/s12306-017-0460-5. The site is secure. Valgus and Varus Stress Test [1] Magee DJ. Reverse Pivot Shift Sign of Jakob, Hassler, and Stubli. . As a stand-alone test, it had a sensitivity of 78% and specificity of 67% the pain was used as the outcome measure and a sensitivity of 91% and specificity of 49% when laxity was the outcome measure. Although sensitivity and specificity values provide useful information, they work against the direction of clinical testing11. N2MzZTc5OGFkMzAwZTZmM2Y1YWFiZTJjMjM3OGNkMmNkM2E4OTYzZWFkMjA5 sharing sensitive information, make sure youre on a federal When refering to evidence in academic writing, you should always try to reference the primary (original) source. In chronic injuries, this test has a sensitivity of 92% and a specificity of 91%, but not in acute injuries. Baker PE, Peckham AC, Pupparo F, Sanborn JC. The test is fairly solid. The wide range of positive likelihood ratios (0.828.86) make it difficult to draw any conclusions about the actual magnitude of this ratio. the tibia moves away from the femur an excessive amount on the lateral aspect of the leg). Pg 791. The varying definitions of a positive McMurray's test are also likely to have contributed to the variability of the results demonstrated by the studies reviewed. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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). Finally, further independent research needs to compare the McMurray's test with modified tests to confirm the apparent superiority of these tests over the McMurray's test. Limiting the search to English language articles only may also have led to an omission of other relevant studies. 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. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh Valgus Stress Test McMurrays test revisited: Evaluation of various methods of performing McMurrays test, Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue SUPP_II, 320. https://www.physio-pedia.com/index.php?title=McMurrays_Test&oldid=322145. 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. Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. Of the four studies that demonstrated the highest shifts in probability, only Corea et al4 and Akseki et al3 contained calculable CIs, which were relatively narrow (Table (Table55). Cinque ME, Geeslin AG, Chahla J, Moatshe G, Pogorzelski J, DePhillipo NN, LaPrade RF. The therapist applies a varus stress at the knee while the ankle is stabilized. McMurray test | Radiology Reference Article | Radiopaedia.org Patients suspected of having a meniscal tear on the basis of history and mechanism of injury excluding those with multiple injuries, history of knee surgery, early clinical and radiographic signs of osteoarthritis, articular cartilage injuries, neurological and musculoskeletal degenerative disorders, disorders of the synovium, acute injuries (less than 4 weeks post-trauma), and any abnormal findings on conventional radiographs. Sae-Jung et al24 considered pain or a clicking sound to be a positive test. In most cases Physiopedia articles are a secondary source and so should not be used as references.