varus stress test sensitivity and specificity

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. In one of these studies, the CIs are extremely wide5. The majority of studies did not report intertester or intratester reliability of the McMurray's test. Bookshelf YzA0Nzk1ZjQxYjY5Mzg4MWUwNDRlODM0NDRiNzZiM2I4OWVhNTQ1YmVlMDNj ODU2Y2M1MDM5YjZiZGYwM2E5ZDEyYjk5Nzc0MTA0ZWQxYmE5MmJiMjRlYWQ2 Grade III: The joint space opens 5 . . Evans et al23 used consecutive patients on a waiting list for arthroscopy for a variety of conditions including, but not limited to, suspected meniscal tears. 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. 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. Level of evidence: Another Systematic review study by Braun Schwieterman found that the sensitivity and specificity of the medial talar tilt stress test was 50% and 88 % respectively. Jaeschke RZ, Meade MO, Guyatt GH, Keenan SP, Cook DJ. Statistical evaluation of McMurray's test in the clinical diagnosis of meniscus injuries. Corea JR, Moussa M, Al Othman A. McMurray's test tested. However, if positive findings are grouped with positive findings from other tests, such as joint line tenderness and Apley's test, the test may be more valid. any of these symptoms can indicate a compromised medial or lateral meniscus. The .gov means its official. Sackett D, Richardson S, Rosenberg W, Haynes RB. Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh Valgus and Varus Stress Test [1] Magee DJ. [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. Zappia M, Capasso R, Berritto D, Maggialetti N, Varelli C, D'Agosto G, Martino MT, Carbone M, Brunese L. Musculoskelet Surg. Future research should concentrate on building a strong methodological base incorporating large samples of consecutive patients with commonly confused pathologies. Rose NE, Gold SM. 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. Although six studies used multiple testers, these did not provide statistics for reliability6,1923. [6] When the knee is extended, the LCL is stretched. The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. The https:// ensures that you are connecting to the NjZjMWViMWE5MzNlMDFhOTA3YzAwYzUzODYzZmQyZGI2ODk1ZmJlOGM4YzZh Ann Chir Gynaecol. 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. Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. These authors excluded subjects with clinical or radiographic evidence of arthritis or fracture that would increase the accuracy of testing but decrease the generalizability of the findings. Kane PW, Cinque ME, Moatshe G, Chahla J, DePhillipo NN, Provencher MT, LaPrade RF. Evidence. Moreover, the ACL stabilizes the knee's rotation under varus or valgus stress. 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. Purpose: 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%. However, they only included patients who had had symptoms for at least one year, making extrapolation of their findings to the acute population challenging. TP=true positive, FP=false positive, FN=false negative, TN=true negative. The fibular or lateral collateral ligament (LCL) is a cord-like band and acts as the primary varus stabilizer of the knee. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. The four possible outcomes include true positive, a false positive, a false negative, and a true negative (see Table Table2).2). 2018 Nov 1;27(6):596-600. doi: 10.1123/jsr.2016-0188. To some degree, this is achieved by sensitivity and specificity, which provide useful information for interpreting the results of diagnostic tests. MTk2NGZhNDE4OTk1NmViZWEyZWM3NzcwNDY0NzA4Y2VmMzBjNjI3MjUwNzdj An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). M2MwN2QyM2QzMGFjZjQ3MDgzMGRiYzAyMmRlZDc3MTAxODc4MDdhNzcyZWMz ZTU5MGVlOWM4MDcwMGE2YmJiZjNjZTBiMjQ2N2E5OTFmNTliZDgyYzc4ZjQ0 Studies by Boeree and Ackroyd19, Akseki et al3, and Karachalios et al21 demonstrated small but sometimes important shifts in probability. 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. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Pg 791. 2017 Dec;33(12):2177-2181. doi: 10.1016/j.arthro.2017.06.028. YzFjZGMyZmVmOTJjNWQ2NWYyNDVkNDE1OWM3Yzg5NjE2MWNhYTY1ZGZlNGYw Likelihood Ratios with confidence: Sample size estimation for diagnostic test results. The wide range of positive likelihood ratios (0.828.86) make it difficult to draw any conclusions about the actual magnitude of this ratio. Consecutive patients. government site. Excluding any with past history of trauma and any with associated fractures, serious arthrosis, previous history of knee surgery or discoid meniscus identified arthroscopically. and transmitted securely. Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests. sharing sensitive information, make sure youre on a federal Epub 2017 Aug 16. Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. InAnnales chirurgiae et gynaecologiae 1987 Jan 1 (Vol. Petty NJ. Limiting the search to English language articles only may also have led to an omission of other relevant studies. There is conflicting evidence with respect to the effect of the presence of an associated anterior cruciate ligament (ACL) deficiency. [1] Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1. [2] Harilainen A. Posterior drawer test Posterior sag test (godfrey test) Quadriceps active test Dial test Varus/valgus stress . 1173185. Interpretation: If the knee joint adducts greater than normal (compared to the unaffected leg), the test is positive. ZDZkZjczMGZkNzQ1OWMxZTQyNDY2ZTAzYTM5OTk2ZmQ1YjkzNDFjMDhmNzMy [4, 6] Thessaly Test. Evidence-Based Medicine: How to Practice and Teach EBM. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). M2ZmZDZjMzRlNTA5MjMyYzZkMGVlMDJkNzM3ODllMjM3ODFmYWJhZjAwYzZh Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Generated by Wordfence at Mon, 1 May 2023 20:49:59 GMT.Your computer's time: document.write(new Date().toUTCString());. Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. Yedlinsky, N.T. 2008. 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. In total, 11 studies have been included in this critical review. 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). This means that tests rarely have both high sensitivity and specificity. These authors also demonstrated that the Medial-Lateral Grind test had smaller (better) LR compared to the McMurray's test although the change in probability was still only small and should be considered rarely important (Table (Table77). Only one study by Harilainen et al. 133k ZDg0M2Q2NDY1ZmIyNjFkZjBiOWE0MzQ3ZjJhZTY1NmRmYTUwYTBiMTNkNTIz Miller RH, Azar FM. Of the studies evaluated in this review, six used the original description of the McMurray's test4,6,20,2224. 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. The preliminary nature of this tool also means that a more narrative review of the validity and accuracy of the tests has been presented. 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. In general, sensitivity figures are much lower than specificity and the CI limits are wider. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). 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. Check for excessive gapping and if you can reproduce the patients pain. The statistical measures of sensitivity, specificity, and likelihood ratios were calculated from the information provided in the studies. Inclusion in an NLM database does not imply endorsement of, or agreement with, The description should include the exact details of the test's application and the criteria used to determine positive and negative results11. 8600 Rockville Pike Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Miller GK. A recent meta-analysis illustrates the difference in test characteristics when performed on patients under anesthesia. An assessment for one-plane lateral instability (i.e. Changing the threshold to increase sensitivity decreases specificity and vice versa. Sae-Jung et al24 considered pain or a clicking sound to be a positive test. IR of the tibia + Varus stress = lateral meniscus, ER of the tibia + Valgus stress = medial meniscus. Churchill Livingstone, 2002. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Review bias may result when the findings of the reference standard test are known by the clinicians performing the diagnostic test. Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. DOI https://doi.org/10.1016/C2009-1-59662-1. Once again, this affects the generalizability of the findings. The site is secure. National Library of Medicine Study with Quizlet and memorize flashcards containing terms like Ballottement, Valgus Stress Test, Varus Stress Test and more. Intertester reliability of clinical judgements of medial knee ligament integrity. Noble J, Erat K. In defence of the meniscus: A prospective study of 200 menisectomy patients. The agreed quality for each paper is included in Table Table33. the contents by NLM or the National Institutes of Health. 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. Studies were eligible for inclusion if they assessed measures of accuracy or validity of the McMurray's test or any modification of this test against a gold standard of either arthroscopy or magnetic resonance imaging (MRI) and were written in English. followers, 277k The use of the STARD tool is also a limitation. An official website of the United States government. 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. Useful tests should produce large shifts in probability once the result of the test is known. Orthopedic Physical Assessment: 5 th Edition. YjRkMzE0ZTk0MWM3ZmIzYWU4Mjc2ZTg2NzY5MWVlZTQwNTFlM2VjN2JkOTYy Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. This was a purposeful strategy designed to enhance their ability to determine the true sensitivity and specificity of the McMurray's test in a population that reflects the symptomatic knee cohort that presents clinically. MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi The inclusion of patients with multiple pathologies is likely to lessen the diagnostic accuracy of a test; however, this would reflect actual clinical practice6,18. 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. Disclaimer. Symptoms related to an intra-articular knee pathology. and transmitted securely. The IR of the tibia followed by extension, the examiner can test the entire posterior horn to the middle segment of the meniscus. 2008 Saunders. They rated the sensitivity at 25% and could not report any specificity . Other signs that have been used to denote a positive test include the production of pain, a clunk, or a pop. Careers, Unable to load your collection due to an error. 1st ed. [1] 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 examiner's arm and trunk. . A prospective evaluation of a test for lateral meniscal tears. 24 General examination included carrying angle (normal, valgus,. M2EwZWY0Zjg3ZDdlZTMzNDhjY2EwMzdkMmRjZmQ1M2M1OTI3ZDRiZDk0NzYx Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. 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. Saunders. 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. $ is the truncation character. New York: Appleton-Century-Crofts, 1976. 2019 Jan 21;8(2):e141-e145. 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. The inclusion of patients with different pathologies would make the results of studies more generalizable to the clinical setting. Given the results of the multivariate regression in Question 1, write the regression equation associated with this study. Failure to do this makes it difficult to determine if the findings of the study can be compared to other studies that have evaluated the same test. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. 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. YWQ2ODI0ODM5NzE5MzVlYTlmMTRmMWEzM2NlYmU4OTViYTkwOTBmNjVjZGFj The Journal of Manual & Manipulative Therapy. Current Orthopaedics. The results support the use of both varus stress radiographs and MRI in diagnosing FCL injuries, because MRI is more sensitive in diagnosing an acute FCL tear, and varus stress radiographs are more sensitive in diagnosing a chronic FCL tear. High specificity indicates that a test can be used for including a condition when it is positive26. No valgus or varus stress is applied. [7] It is commonly associated with other knee ligament injuries, thus LCL tear can be easily overlooked as a result of that. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). MjI0NTIxNTI4MWM3YmNjNGMwMDU2Mjk4ZWM1MzcyMDNkZTAyYmNhMDljZTU1 A wide variety of clinical tests are used to diagnose meniscal pathology within the knee joint. Federal government websites often end in .gov or .mil. 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. A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. The reliability of this test in extension is 68% and in 30 flexion only 56%. They also fail to take into account pre-test probability. eCollection 2019 Feb. The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is unlocked.1. Three studies used only one tester4,5,25, and two studies did not mention how many examiners were used3,24. followers, 712k 2nd ed. Bethesda, MD 20894, Web Policies Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. ZmFjMDhjZmYyOWRiNWU2YjhhMWNhYjFiNTU5YTI5ODM3MTY1ODYwYzc2NmFi Currently, a triple phase technium-99 bone scan (scintigraphy) is the most accurate method of diagnosing stress fractures with a sensitivity of 100% and specificity of 76%. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears Arthroscopy. Knee, McMurray's, Meniscal, Reliability, Sensitivity, Specificity, Testing, Validity. YTY1NDM4NjNkYzAwMmMxNGU2MjgwMmMzODFlMTZkZmQyYjRmNTAzM2RkZWY4 One problem with these modified tests is that they appear to have all been evaluated by the creators of the tests, which to some degree challenges the validity of the research. Simmel DL, Samsa GP, Matchar DB. The sensitivity and specificity of the McMurray's test reported in the studies identified in this review vary widely (Table (Table5).5). Akseki et al3 included consecutive patients with symptoms related to intra-articular knee pathology although how this was determined was not described. 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. J Sport Rehabil. 76, No. The proportion of people who do not have the disease or dysfunction who test negative. Fibular collateral ligament and the posterolateral corner. While it is difficult to compare results across studies due to the differences in the tests being used, the results of this review appear to show that the modified tests have higher diagnostic value than the McMurray's test. Philadelphia: Wolters Kluwer, 2010. Purpose: The Varus Stress Test is used to assess the integrity of the LCL or lateral collateral ligament of the knee. Four studies demonstrated that a positive test alters the probability to only a small, rarely important degree5,6,25, suggesting uncertainty that a positive test will indicate meniscal pathology (Table (Table5).5). Arthroscopy. The test is first done with the knee in full extension and then with the knee in 20-30 degrees of flexion. Douglas I, McDermott Meniscal tears. Measures of efficacy include accuracy, sensitivity, and specificity. Varus Stress Test of the Knee: Genu Varum (aka bow-leggedness, bandiness, bandy-leg, and tibia vara), is a physical deformity marked by (outward) bowing of the lower leg in relation to the thigh, giving the appearance of an archer's bow. Philadelphia: Elsevier, 2016; 2121-2297. Described a modified version (Medial-Lateral Grind test) but no description of McMurray's. Specificity: the ability of a test to correctly identify people without the disease. Human Kinetics, 2008. 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. MWU3NjBlM2FlMDU2YWM3ODA4ZGIyZTNjODFkOWU2ZDBkMGNiYzRhZjE2MGRk 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. Varus Stress Test [1] Magee DJ. Sensitivity and specificity of this test are only 38% and 41%, respectively. 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. 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. The test is performed at 0 and 20-30, so the knee joint is in the closed packed position. Consider reproduction of pain during the test as a positive test, not just the reproduction of a. Four authors stated that they used the McMurray's test but did not describe the actual testing procedure3,5,19,25. Grade II: The joint space opens 3-5 mm more than the contralateral side in 20 degrees of knee flexion and less than 2 mm more than the normal knee in full extension. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. There are also discrepancies in the studies as to what constitutes a positive McMurray's test. Bethesda, MD 20894, Web Policies The final two studies20,21 limited their study population to patients suspected of meniscal injury. 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. Orthopaedics - A guide for practitioners. [5] The LCL further splits the biceps femoris into two parts. MDU1NWE1Nzc5OGVjNTczOGU2OWUyMWYxYmY3Njk5ZTdlMDEwZTQ3MTY0Zjdm official website and that any information you provide is encrypted H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). Valgus Stress Test. The purpose of this paper was to assess the literature investigating the validity and diagnostic accuracy of the McMurray's test (and modifications) for determining meniscal pathology of the knee so that conclusions could be drawn regarding its clinical usefulness as a test. Bhandari M, Guyatt GH. ZmNhYzI5Njc5MTEwZGU2NTAzYmRjNmJiODlmMmU0N2FhYzFhMDRjNjQ1YTNk 4th Edition. 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