varus stress test sensitivity and specificity

The fibular or lateral collateral ligament (LCL) is a cord-like band and acts as the primary varus stabilizer of the knee. High sensitivity indicates that a test can be used for excluding a condition when it is negative, but it does not address the value of a positive test. [8]The test has therefore often been reported to be of limited value in current clinical practice. Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. However, in general, the CI limits are relatively narrow over all. Place the affected leg in extension and slight external rotation. These results have been supported by Karachalios et al21, who compared another weight-bearing modification (the Thessaly test) of the McMurray's with the original test. government site. A positive result at both 0 and 20 indicate cruciate ligament involvement. A recent study by Winters and Tregonning13 showed a diagnostic accuracy for MRI to be 90% for the medial meniscus and 82% for the lateral meniscus. Review of meniscal injury and associated sports. Based on MRI, overall specificity was 68%. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. However, they only included patients who had had symptoms for at least one year, making extrapolation of their findings to the acute population challenging. Measures of efficacy include accuracy, sensitivity, and specificity. Unauthorized use of these marks is strictly prohibited. Test Position: Supine. [7] It is commonly associated with other knee ligament injuries, thus LCL tear can be easily overlooked as a result of that. ZmZjN2MzNzdhZDFlZWY2OGI0YWExNTViZjA5ZDc3OTA3MTJmYTYyOGFmMGEw Schnke M, Schulte E, Schumacher U. Prometheus deel 1: Algemene anatomie en bewegingsapparaat. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. 1. Grade III: The joint space opens 5 . Ocassionally, the LCL is congenitally absent. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. Additionally, the single photon-emission CT scan is receiving a lot . official website and that any information you provide is encrypted The review also highlights the idea that modified versions of the test seem to be more valid than the original version. 269-273). ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz Physical examination consisted of general elbow examination and specific examination of the distal biceps based on literature. OGNkMmFkZGY0YjIxNzkxN2RkOTg3YzgzMTdiYjY1OGMxMzA2NThmZjIxNGNi Whiting WC, Zernicke RF. Other studies3,5,19 commented that greater clinical experience may affect the results of the test but they did not provide any statistical evidence to support this assertion. However, for medial meniscal tears, rates are lower. Akseki et al3 compared the McMurray's test with a weight-bearing version of the McMurray's test that incorporated axial compression and varus/valgus stress, with the patient squatting down in internal and then external rotation (Ege's test). Effect of Sectioning of the Anterior Cruciate Ligament and Posterolateral Structures on Lateral Compartment Gapping: A Randomized Biomechanical Study. Referred from GP/A&E with suspected cruciate ligament or meniscal pathology. Diagnostic accuracy of a new clinical test (the fiessaly Test) for early detection of meniscal tears. Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. Obviously, if the test is performed differently and/or the interpretation of a positive test is not the same, the demonstrated accuracy of the test cannot be compared. FOIA Performing the Test: The patient's leg should be relaxed for this test. Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw These comments are also supported by the findings of a recent meta-analysis carried out by Hegedus et al7 and Meserve et al8. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. [2]Meniscal tears may occur in acute knee injuries in younger patients or as part of a degenerative process in older individuals. In most cases Physiopedia articles are a secondary source and so should not be used as references. These authors also demonstrated that the Medial-Lateral Grind test had smaller (better) LR compared to the McMurray's test although the change in probability was still only small and should be considered rarely important (Table (Table77). Results also indicate that testing for medial meniscal pathology is more sensitive than testing for lateral; however, tests for lateral meniscal pathology are more specific than tests for medial pathology3,4,19. Published by Elsevier Inc. All rights reserved. This, along with the conclusions discussed above, suggests that the McMurray's test should be used as one of a combination of tests in the clinical setting3,22,23. ODFlNzFkZTQ2MDZmOTVkM2Q1MjEzNzY5YTlmZTU2MTRmYWFkYzY2ZmRmNzlj In total, 11 studies have been included in this critical review. Although blinding was not mentioned in respect to the other studies, the majority required the clinical examination to be performed prior to the diagnostic arthroscopy, suggesting that the examiner would indeed be blinded to the results of the diagnostic test. any of these symptoms can indicate a compromised medial or lateral meniscus. Consider the use of modifications of the test for improved validity. MTk2NGZhNDE4OTk1NmViZWEyZWM3NzcwNDY0NzA4Y2VmMzBjNjI3MjUwNzdj One study used a palpable thud and/or pain23, and two studies used a palpable click and/or pain3,20. The other hand provides a varus stress to the ankle. In chronic injuries, this test has a sensitivity of 92% and a specificity of 91%, but not in acute injuries. There is conflicting evidence in the literature over the accuracy of MRI. Limiting the search to English language articles only may also have led to an omission of other relevant studies. An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). The technical storage or access that is used exclusively for anonymous statistical purposes. YmRhYTcyZWFhNTQ5OTM0YWYwODRjZDU1OWU3ZjBjNmMyMjA4NTcxZTRmMDYw MeSH Harilainen A. However, these authors stated that they determined these findings in a study of 20 subjects prior to the main study and they did not provide any details of how this pilot study was performed or analyzed. Original Editors - Dorien Scheirs, Joris De Pot, Top Contributors - Saimat Lachinova, Admin, Joris De Pot, Dorien Scheirs, Kim Jackson, Rachael Lowe, Leana Louw, Oyemi Sillo, WikiSysop, Tony Lowe, Derycker Andries, Naomi O'Reilly, George Prudden and Kai A. Sigel. How likely a positive test result is in people who have the disease or dysfunction as compared to how likely it is in those who do not have the disease or dysfunction. Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests. Evidence. In addition, cited references of relevant articles were examined. Four authors stated that they used the McMurray's test but did not describe the actual testing procedure3,5,19,25. Fowler and Lubliner22 had a similarly broad population in that they included consecutive patients who warranted arthroscopic examination for any reason. . The technical storage or access that is used exclusively for statistical purposes. Moreover, the ACL stabilizes the knee's rotation under varus or valgus stress. As the knee goes into flexion, the LCL loses its significance and influence as a varus-stabilizing structure. Value of the physical examination. Further, the description of the test itself should be well explained, and improving intertester reliability in the future would increase the validity of the studies. MRI has also shown to be highly reliable, but due to its expensive cost, they are less frequently used. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. Fowler and Lubliner22 attributed their low sensitivity results (compared to previous studies)5,25 to population differences between the studies (Table (Table5).5). The sensitivity was 87% for the medial meniscus but only 46% for the lateral meniscus13. Before Then he applies a strong valgus force, with a counterforce applied at the . The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. These authors demonstrated significantly larger (better) positive likelihood ratios and significantly smaller (better) negative likelihood ratios than the McMurray's. Physical examination of the knee, inThe Sports Medicine Resource Manual, Editors: Seidenberg, P.H & Beutler, A..I. When refering to evidence in academic writing, you should always try to reference the primary (original) source. One problem with these modified tests is that they appear to have all been evaluated by the creators of the tests, which to some degree challenges the validity of the research. Once again, this affects the generalizability of the findings. Comparison of likelihood ratio's for McMurray's test with modified tests. 3rd edition. Would you like email updates of new search results? Fowler PJ, Lubliner JA. Patient in supine. Partial Controlled Early Postoperative Weightbearing Versus Nonweightbearing After Reconstruction of the Fibular (Lateral) Collateral Ligament: A Randomized Controlled Trial and Equivalence Analysis. Test (b): Disease Status test (b) results *Positive Negative Present 18 7 25 absent 2 73 75 total 20 80 100 Calculate the sensitivity, specificity, positive predictive values, and negative predictive values for each test. As a library, NLM provides access to scientific literature. Fibular collateral ligament and the posterolateral corner. HHS Vulnerability Disclosure, Help followers, 277k The test is performed at 0 and 20-30, so the knee joint is in the closed packed position. Likelihood Ratios with confidence: Sample size estimation for diagnostic test results. sharing sensitive information, make sure youre on a federal Purpose: The varus stress test shows a lateral joint line gap. The studies by Akseki et al3, Corea et al4, and Manzotti et al20 revealed negative likelihood ratios that are slightly lower than the other studies. ZDIwNGI3MGM0NDMzZmMxM2YxZDdmZWM0YmE5MDI5OWJiMmE4MmFhZTdkODE1 Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). HHS Vulnerability Disclosure, Help Consequently, it is likely that the accuracy of meniscal testing demonstrated by this study is artificially high compared to studies with a wider inclusion criteria. Consecutive patients with knee pain of at least one year's duration that warranted arthroscopic investigation. The STARD checklist contains 25 items that help to make a judgment about potential bias in the study and appraisal of the applicability of the findings. Also described a weight-bearing modification of McMurray's (Thessaly test), n/m for McMurray's, but joint line discomfort and possibly a sensation of locking or catching for Thessaly test. MDU1NWE1Nzc5OGVjNTczOGU2OWUyMWYxYmY3Njk5ZTdlMDEwZTQ3MTY0Zjdm Only one study by Harilainen et al. The acute tears frequently result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee.[3]. Based on the STARD scoring of each paper, it is possible to make a qualitative assessment about the methodological quality. This lack of consensus in the literature highlights the risk that the criteria indicating a positive test can influence the test outcome, irrespective of whether the test was performed in the same manner on the same patient. ODA1ZGIwMjcwNDYzZDc3OTkwMWYwNWVkMWRlYzk1ZWExOTVhNjBiNWQ2MzUw 2006;20:8594. Specificity: not reported. This is not surprising given the complicated nature of the technique and the difficulty in controlling the amount and direction of forces across testers. Consider the findings of this test in conjunction with those of other tests to enhance the likelihood of a correct diagnosis such as joint line tenderness. There are also discrepancies in the studies as to what constitutes a positive McMurray's test. A prospective evaluation of a test for lateral meniscal tears. Accessibility H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). MDUwOTJiNWVjMDExNzg5OTRkYzIwNjRlYzdhZmM2MzUyYjUwY2IxYTkzMTRk [2] Harilainen A. Evans et al23 demonstrated a low level of agreement between the two examiners with intertester agreements ranging from poor for reproduction of a medial sensation (Kappa = 0.10) to fair (K = +0.38) for lateral pain. Finally, further independent research needs to compare the McMurray's test with modified tests to confirm the apparent superiority of these tests over the McMurray's test. Miller RH, Azar FM. Diagnosis of acute knee ligament injuries: The value of stress radiography compared with clinical examination, stability, under anesthesia and arthroscopic or operative findings. Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. how likely a negative test result is in people who have the disease or dysfunction as compared to how likely it is in those who do not have the disease or dysfunction. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); We use cookies to optimize our website and our service. Biomechanics of musculoskeletal injury. While it is difficult to compare results across studies due to the differences in the tests being used, the results of this review appear to show that the modified tests have higher diagnostic value than the McMurray's test. The agreed quality for each paper is included in Table Table33. [1] It is one of 4 critical ligaments involved in stabilizing the knee joint. The reported incidence of ACL sprains and tears in the knee injuries. A guide to the interpretation of likelihood ratio (LR) values. Although these authors mentioned that the examiners were blinded to the results of the MRI, they did not make it clear if the examiners knew that there were a similar number of normals and symptomatic subjects included in the study or if they knew which group each individual subject belonged to. Top Contributors - Rachael Lowe, Admin, Adrian Shaji, Kim Jackson, Evan Thomas, Amanda Ager, Kai A. Sigel, Wanda van Niekerk, Tony Lowe, Tyler Shultz and WikiSysop, Meniscus tears are the most common injury of the knee. The accuracy measure has limited usefulness in that it does not distinguish between the diagnostic value of positive and negative results11. Results: [5], The LCL stabilizes the lateral side of the knee joint, mainly in varus stress and posterolateral rotation of the tibia relative to the femur. Similarly, sensitivity figures ranged from 27% to 70% across the reviewed papers, generally indicating that a torn meniscus is likely to be missed in many patients; however, specificity figures (2996%) indicating that false positive tests are relatively low and that a positive test makes it likely that the patient actually does have a torn meniscus. xenia ohio tornado 1999, best sports journalism schools in the world, richard hadfield partner,

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