Critically Appraised Topic
At the outpatient orthopedic clinic that I am currently at we tend to see a lot of knee patients, both acute and post-operative. When I was reviewing the different orthopedic special tests for the knee with my CI, I was asked about the Thessaly Test and what I knew about it. Having never heard of that test before, I was told that it is the best test to use to test for meniscal injuries. This led me to my clinical question of which orthopedic special test for the knee, specifically the Thessaly Test, has the best diagnostic criteria to rule in or out meniscal injuries.
What orthopedic special test for the knee, including the Thessaly Test, has the best diagnostic criteria to rule in or out injuries to the meniscus?
Clinical Bottom Line
Overall both articles closely matched my clinical question comparing a number of clinical diagnostic tests for medial and lateral meniscus involvement. Both articles demonstrated high specificity for the Thessaly Test at 20⁰ of flexion for diagnosing lateral meniscus tears, whereas the article by Karacholios et al. also found high sensitivity and specificity for the Thessaly Test at 20⁰ of flexion for diagnosing medial meniscus tears. The second article by Konan et al. also found that Joint-line tenderness and McMurray’s had high specificity for ruling in lateral meniscus involvement. Further studies with larger sample sizes and a less-strict exclusion criteria need to be conducted to further analyze this information. At this point, medial and lateral meniscus tears should be clinically diagnosed by history, mechanism of injury, and clinical examination through use of the Thessaly test at 20⁰ of flexion for medial meniscus and a combination of the Thessaly test at 20⁰ of flexion, McMurray’s and Joint-line tenderness for lateral meniscus. Magnetic Resonance Imaging should be used as a second-line screening tool for confirmation of positive clinical tests of meniscus injury prior to arthroscopic surgery.
Horn, Alison, "Diagnostic Accuracy of Orthopedic Special Tests for Meniscal Injury" (2011). PT Critically Appraised Topics. 3.