Evaluating a meniscus injury can be a tough task. There are a lot of false positives, and some can actually create more damage to the meniscus if it is indeed hurt. The best identifier for a meniscal injury is the history and mechanism of injury. The rest of the orthopedic tests seem to lack sensitivity and specificity. Joint line tenderness has always been an ok test, but only for the lateral meniscus.
Most doctors if suspecting a meniscal injury will go right to an MRI. Well, MRI's have an accuracy rate of 98%, but they are expensive. If you don't have great health insurance, your looking at a pretty penny out of pocket. This should in fact be a 2nd line of screening.
The Thessaly Test is a new test that has a 94% accuracy rate for medial meniscus and 96% for the lateral meniscus. It is performed with the patient firs standing on the good leg to get the maneuver down. Then on the suspected leg. On one leg bend the knee so there is 20 degrees of flexion. Internally and Externally rotate the body as the foot stays in place. This places a torgue on the knee. It helps to have the examiner hold the hand of the patient for balance.
The study done with the Thessaly Test was done with 213 patients. A pretty solid sample pool. No acute knees (knees hurt with in 4 weeks) were evaluated. Exclusion criteria included, multiply knee injuries, history of knee surgery, osteoarthritis and synovium disorders.
This seems to be a pretty solid test to add in your tool bag for a first line screen for meniscal injuries. My only thought on this study is if the exclusion criteria were included would the rate of accuracy go down?
Here is an abstract of the STUDY.
4 comments:
My only thought on this test aside from the point you bring up is, what damage you may cause if there is a cleavage of the articular cartilage of the femur and you are then grinding it in under load to the meniscus...this often happens with meniscus tears. The other is from reading your post I took it as that no acute injuries were evaluated....Most meniscus issues where I may want a quick intervention and MRI need to be evaluated soon....I choose to MRI if suspected from MOI. I try not to let my recommendations for most appropriate and best patient care be dictated by finances....What would I suggest if it was my Knee. Just a thought.
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very neatly explained , it will help many to deal with pain .
Thanks for sharing the post. It was really helpful.
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