The determination of the diagnostic value of reverse mcmurray test for meniscal tears.

INTRODUCTION AND AIMThe knee-joint disease which is one of the most important patient groups of orthopedic polyclinics has been increased recently. Our aim is to examine a little known examination method for the diagnosis of those diseases instead of common physical examination methods. In our study, the detailed examination of the patients with paradoxical findings in conventional McMurray test for meniscal tears is aimed. Our objective is to examine the positive findings of the paradoxical McMurray test in detail and then to determine whether a diagnostic value exists or not according to the type of the meniscal tear and its place. This examination method does not require any additional time and experience so its application is simple and fast. As far as we know, there is only one study indicates this paradoxical phenomena.Hypothesis: The determination of the diagnostic value of paradoxical McMurray Test for different meniscal tears and their places.PATIENTS AND METHODThe required archive for our study was recorded by only one orthopedic surgeon (H.P.). And the information of the patients who were examined and had their arthroscopies by same surgeon was noted down into forms in detail. The patients for this study were obtained by retrospectively scanning of the archive.After the retrospective scanning, the files of the patients that never have any knee-joint operation and had complete information were separated. Then 719 patients were included to the study. In these patients, the positive paradoxical McMurray test findings obtained in 91 cases. The detailed examination of these 91 patients was made according to the types of the meniscal tears and their places. The diagnostic value of this test was investigated by associating it with paradoxical McMurray Test. And also the analysis of the cartilage lesions which are thought to play a role in the positiveness of this test was made. SSPS software was used for statistical calculations of the findings. Chi square test, kappa value, sensitivity and specificity analysis and test reliability were used for calculations.FINDINGSWhen 91 patients were examined according to the meniscal tears, it was seen that the sensitivity for both medial and lateral meniscus was low (9.4 %and 12.4 % respectively). Relatively high values were obtained in specificity (95.8% and 96% respectively). According to these tests, the test reliability was low and the kappa value was taken as meaningless. In the cases that the test is positive, complex and longitudinal tears found mostly. The most common compartment of medial meniscal tear was the posterior half of the menisci. The chondral lesions were scanned whether to see that the paradoxical McMurray test accompanies another knee-joint pathology or not. The sensitivity and specificity for tibia cartilage damages were found as 13.3% and 87.9% respectively. For femur cartilage damage the sensitivity and specificity values were found as 12.5% and 87.2% respectively. For patella the sensitivity and specificity values were obtained as 13.3% and 87.8% respectively. Meniscus laxity and cysts which are important pathologies were examined. Meniscus laxity was found in 15 patients and meniscus cysts were seen in 9 patients. But no statistically significant result was obtained. It was investigated that whether the McMurray test has a contribution to correct positiveness and negativeness or not and it was found that it has no positive contribution and no case was determined which decreases the accuracy rate.CONCLUSIONNo statistically significant result was obtained although the paradoxical McMurray test gave positive findings about meniscus laxity (medial meniscus laxity 11/47; exterior meniscus laxity 4/7). In the evaluation of meniscal tears high specificities were obtained as very low sensitivities were found. Therefore, the test reliability was found as low. We think that the modified form of this test will give more detailed information with a prospective study.