Clinical Diagnosis of Meniscal Tears – Journal Club
Date: Sept. 26, 2017
Presenter: John C. Presvelos
Ercin E, Kaya I, Sungur I, Demirbas E, Ugras A, Cetinus E. History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions. Journal of Knee Surgery, Sports Traumatology, and Arthroscopy 20:851-856 (2012)
This was a prospective study with the goal of correlating the history, clinical examination, MRI and arthroscopic findings in the diagnosis of meniscal tears to determine the reliability and value of an experienced knee surgeon in clinical decision making. The authors concluded that using MRI as a routine diagnostic supplement is unnecessary and that a thorough clinical assessment can provide sufficient information for the surgeon to make a definitive preoperative diagnosis.
|· Reinforced importance of accurate clinical examination and reviewed a variety of meniscus test techniques
· Demonstrated increased accuracy with increase in clinical experience
· Straightforward, intuitive statistics were used making the results easy to understand and interpret
|· Selected a population with a high pretest probability for meniscus tear and small population (30 patients), which could effect the external validity of the study
· No mention of blinding in the study, which creates a high potential for bias in results. The same surgeon was performing the examination and the arthroscopy
Rinonapoli G, Carraro A, Delcogliano A. The clinical diagnosis of meniscal tears is not easy. Reliability of two clinical meniscus tests and magnetic resonance imaging. International Journal of Immunopathology and Pharmacology 24(1):39-44 (2011)
This was a prospective study with the goal of evaluating the reliability of McMurray’s and Apley’s tests and MRI in the diagnosis of meniscal tears. The authors concluded that the history, clinical examination, and MRI should be combined to come to an accurate diagnosis.
|· Calculated and compared statistics for each of the meniscal tests separately and in combination.
· Blinding of examiners to patient history, previous examination, and MRI results
|· Looked at a relatively homogenous population with post-traumatic meniscal tears without commonly co-morbid conditions.
· Mention that the examiners performed 6 meniscus tests but analysis was only performed on 2. Did not mention which other tests were performed or why these were not included