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Titre : | Joint Line Tenderness and McMurray Tests for the Detection of Meniscal Lesions: What Is Their Real Diagnostic Value? (2013) |
Auteurs : | Marco Galli ; Vincenzo Ciriello ; Amerigo Menghi ; et al. |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (2013/6, 2013) |
Article en page(s) : | pp. 1126-1131 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Arthroscopie ; Diagnostic ; Genou ; Rééducation et réadaptation ; Sensibilité et spécificité |
Mots-clés: | Arthroscopy ; Knee ; Menisci ; Tibial ; Ménisques de l'articulation du genou ; Sensitivity and Specificity |
Résumé : |
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. Interventions Not applicable. 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 κ 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. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/archives-of-physical-medicine-and-rehabilitation |