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Evaluation of the diagnostic accuracy of clinical examination for diagnosing medial meniscal injuries using arthroscopy

Mannan M, Khalil S, Iqbal MA, Karim F, Hameed MH, Shrivastava N, Tayyab M, Shan RR

Cureus 2025 Jul 29;17(7):e89026

primary study

INTRODUCTION Traditional manoeuvres such as the McMurray's test and the Apley compression test have low diagnostic accuracy when performed in isolation. However, by combining these tests, higher accuracy can be found. The superficial anatomy of the knee enables diagnosis of the injury through a thorough history and physical examination. OBJECTIVE The objective of this study is to determine the diagnostic accuracy of a combination of physical examination tests, such as Apley's test, McMurray's test, and joint line tenderness, for diagnosing medial meniscal injuries using arthroscopy as the gold standard. MATERIALS AND METHODS This cross-sectional study was conducted over a duration of 12 months, from February 15, 2021, to February 15, 2022, in the Department of Orthopedics at Ghurki Trust Teaching Hospital, Lahore, Pakistan. A total of 185 patients who met the inclusion criteria were enrolled in the study after obtaining approval from the hospital ethics committee. Informed consent was obtained from each patient or their attendant prior to participation. All clinical examinations and arthroscopic procedures were performed by a single experienced consultant to ensure consistency. The clinical examination included Apley's test, joint line tenderness test, and McMurray's test, and findings were recorded as positive based on predefined operational definitions. Arthroscopic evaluations were performed under spinal anaesthesia during definitive surgical procedures, and medial meniscal injury was diagnosed in accordance with the operational definition. RESULTS The mean age of patients was 48.54 +/- 11.49 years, with a minimum and maximum age of 18 and 65 years. There were 119 (64.3%) male and 66 (35.7%) female cases. On arthroscopy, the medial meniscal injury was diagnosed in 127 (68.65%) of the cases, and on clinical examination, it was found in 122 (65.95%) of the cases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the clinical examination were 90.55%, 87.93%, 94.26%, 80.95% and 89.73%, respectively. CONCLUSION It is concluded that the diagnostic accuracy of clinical examination for the diagnosis of medial meniscal injury was good when arthroscopy was taken as the gold standard. Hence, in the future, we can rely on clinical examination for diagnosis for patients who have a fear of undergoing arthroscopy. Arthroscopy can be used to treat these injuries in patients willing to undergo treatment. With better diagnostic accuracy, we can treat these cases timely manner to avoid further degenerative changes of the cartilage in the medial compartment of the knee.

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