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Diagnostic Accuracy of a New Clinical Test (the Thessaly Test) for Early Detection of Meniscal Tears

¹ Orthopaedic Department, School of Medicine, Faculty of Health Sciences, University of Thessaly, 22 Papakyriazi Street, Larissa 41222, Hellenic Republic, Greece. E-mail address for T. Karachalios: kar{at}med.uth.gr
² Department of Computerized Tomography and Magnetic Resonance Imaging, General Hospital of Larissa, 1 Tsakalof Street, Larissa 41221, Hellenic Republic, Greece

Investigation performed at the Orthopaedic Department, University of Thessaly, Larissa, Hellenic Republic, Greece

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: Two hundred and thirteen symptomatic patients with knee injuries who were examined clinically, had magnetic resonance imaging studies performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers who were examined clinically and had magnetic resonance imaging studies done of their normal knees were included in this study. For clinical examination, the medial and lateral joint-line tenderness test, the McMurray test, the Apley compression and distraction test, the Thessaly test at 5° of knee flexion, and the Thessaly test at 20° of knee flexion were used. For all clinical tests, the sensitivity, specificity, false-positive, false-negative, and diagnostic accuracy rates were calculated and compared with the arthroscopic and magnetic resonance imaging data for the test subjects and the magnetic resonance imaging data for the control population.

Results: The Thessaly test at 20° of knee flexion had a high diagnostic accuracy rate of 94% in the detection of tears of the medial meniscus and 96% in the detection of tears of the lateral meniscus, and it had a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of joint-line tenderness, which presented a diagnostic accuracy rate of 89% in the detection of lateral meniscal tears, showed inferior rates.

Conclusions: The Thessaly test at 20° of knee flexion can be used effectively as a first-line clinical screening test for meniscal tears, reducing the need for and the cost of modern magnetic resonance imaging methods.

Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.

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