Article

OBJECTIVES: To assess the interobserver concordance of the joint line tenderness
(JLT) and McMurray tests, and to determine their diagnostic efficiency for the
detection of meniscal lesions. DESIGN: Prospective observational study. SETTING:
Orthopedics outpatient clinic, university hospital. PARTICIPANTS: Patients (N=60)
with suspected nonacute meniscal lesions who underwent knee arthroscopy.
MAIN OUTCOME MEASURES: Patients were examined by 3
independent observers with graded levels of experience (>10y, 3y, and 4mo of
practice). The interobserver concordance was assessed by Cohen-Fleiss kappa
statistics. Accuracy, negative and positive predictive values for prevalence 10%
to 90%, positive (LR+) and negative (LR-) likelihood ratios, and the Bayesian
posttest probability with a positive or negative result were also determined. The
diagnostic value of the 2 tests combined was assessed by logistic regression.
Arthroscopy was used as the reference test. RESULTS: No interobserver concordance
was determined for the JLT. The McMurray test showed higher interobserver
concordance, which improved when judgments by the less experienced examiner were
discarded. The whole series studied by the "best" examiner (experienced
orthopedist) provided the following values: (1) JLT: sensitivity, 62.9%;
specificity, 50%; LR+, 1.26; LR-, .74; (2) McMurray: sensitivity, 34.3%;
specificity, 86.4%; LR+, 2.52; LR-, .76. The combination of the 2 tests did not
offer advantages over the McMurray alone. CONCLUSIONS: The JLT alone is of little
clinical usefulness. A negative McMurray test does not modify the pretest
probability of a meniscal lesion, while a positive result has a fair predictive
value. Hence, in a patient with a suspected meniscal lesion,
a positive McMurray
test indicates that arthroscopy should be performed. In case of a negative
result, further examinations, including imaging, are needed.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS