Table of ContentsView AllTable of ContentsPhysical ExamMcMurray TestApley TestThessaly TestEge’s TestMRI ScanArthroscopy
Table of ContentsView All
View All
Table of Contents
Physical Exam
McMurray Test
Apley Test
Thessaly Test
Ege’s Test
MRI Scan
Arthroscopy
There are several tests commonly used to diagnose ameniscustear. The investigation will typically start with a review of your medical history, a physical exam, and a battery of in-office tests known as the McMurray, Apley, Thessaly, andEge’stests.
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Physical Examination
A meniscus is a C-shaped piece of cartilage that acts as a shock absorber between the shinbone and thighbone.Atorn meniscuscan often be difficult to diagnose because the severity of the pain rarely corresponds to the location ortype of tearyou have.
Because of this, a meniscus tear is rarely diagnosed based on a medical history and a physical exam, even among experiencedorthopedists.
To kick off the investigation, the orthopedist will look for tell-talesigns of a meniscus tear, including:
In addition topalpation(light touching), the orthopedist will perform a battery of in-office tests to detect a torn meniscus based on the manipulation of the knee.
The McMurray Test is the classic manipulation test for meniscal tears. It involves the full flexion (bending) and rotation of the knee. The movements are similar to those used in daily activities.
The McMurray Test is performed as follows:
The McMurray Test is positive if a click is heard or felt while rotating and extending the knee. The test has a sensitivity of around 80%, meaning that it can correctly diagnose a meniscus tear in eight of 10 cases.
To do the Apley Test:
The Apley Test is considered positive if there is pain or a “catching” sensation with compression or rotation. The test is less sensitive than the McMurray Test, with a sensitivity of roughly 65%.
The Thessaly Test is performed on your feet. It is more accurate than the others in detecting medial tears (affecting the inner knee).
The Thessaly Test is performed as follows:
The Thessaly Test is considered positive for a tear if you experience pain or the “locking” or “catching” of the knee during rotations. The test has a sensitivity of roughly 73%.
The Ege’s Test is another standing test, sometimes referred to as the McMurray Weight-Bearing Test, which involves a series of squats and knee rotations.
To do the Ege’s Test:
The Ege’s Test is positive if a click is heard or felt while squatting. The test has a sensitivity of roughly 70%, meaning that a tear is correctly diagnosed in seven of 10 cases.
Imaging Studies for Meniscus Tear
Because the McMurray, Apley, Thassely, and Ege’s tests are far from perfect, imaging studies are almost invariably ordered as part of the investigation. This is true even if the tests are negative as a negative resultdoes notrule out a meniscus tear as a cause.
Plain X-rays are not recommended for the diagnosis of meniscus tears and even acomputed tomography (CT) scanwhich composites multiple X-ray images has its limitations.
Magnetic resonance imaging (MRI)is the imaging study of choice for meniscus tears. The technology uses powerful magnetic and radio waves to create highly detailed images of soft tissue, such as cartilage.
On its own, an MRI has a sensitivity of around 88%. When combined with two other positive in-office test results, the accuracy may increase to well over 90%.
Less commonly,arthroscopymay be needed to definitively diagnose a meniscus tear. This minimally invasive surgery is commonly performed underlocal anesthesiato view inside the knee joint space.
Arthroscopy involves one or several tiny “keyhole” incisions through which is lighted fiber-optic scope (called an arthroscope) is inserted to check for ruptures (tears) in the joint cartilage.
Arthroscopy is generally avoided unless there is a therapeutic purpose for the procedure. This may be the case if a known injury such as ananterior cruciate ligament (ACL) tearneeds repair, but a meniscal tear is only suspected.
Summary
The diagnosis of a meniscal tear commonly starts with a review of your medical history, a physical exam, and in-office tests like the McMurray, Apley, Thassely, and Ege’s tests. These tests help detect a tear based on manipulation of the knee.
Although the diagnosis can almost always be confirmed with a magnetic resonance imaging (MRI) scan, certain cases can only be positively diagnosed during arthroscopic knee surgery.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bhan K.Meniscal tears: current understanding, diagnosis, and management.Cureus. 2020;12(6). doi:10.7759/cureus.8590American Academy of Orthopaedic Surgeons.Meniscus tears.Duong TD, Tran DT, Do BNT, Tran HT, Le SM, Vu TT.Diagnostic value of clinical tests and Mri for meniscal injury in patients with anterior cruciate ligament injury: case series study.Int J Surg Case Rep.2021;88:106491. doi:10.1016/j.ijscr.2021.106492Blyth M, Anthony I, Francq B, et al.Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley’s, McMurray’s and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis.Health Technol Assess.2015 Aug;19(62):1-62. doi:10.3310/hta19620Gupta Y, Mahara D, Lamichhane A.McMurray’s test and joint line tenderness for medial meniscus tear: are they accurate?Ethiop J Health Sci. 2016;26(6):567-572. doi:10.4314/ejhs.v26i6.10American Academy of Orthopedic Surgeons.Knee arthroscopy.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bhan K.Meniscal tears: current understanding, diagnosis, and management.Cureus. 2020;12(6). doi:10.7759/cureus.8590American Academy of Orthopaedic Surgeons.Meniscus tears.Duong TD, Tran DT, Do BNT, Tran HT, Le SM, Vu TT.Diagnostic value of clinical tests and Mri for meniscal injury in patients with anterior cruciate ligament injury: case series study.Int J Surg Case Rep.2021;88:106491. doi:10.1016/j.ijscr.2021.106492Blyth M, Anthony I, Francq B, et al.Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley’s, McMurray’s and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis.Health Technol Assess.2015 Aug;19(62):1-62. doi:10.3310/hta19620Gupta Y, Mahara D, Lamichhane A.McMurray’s test and joint line tenderness for medial meniscus tear: are they accurate?Ethiop J Health Sci. 2016;26(6):567-572. doi:10.4314/ejhs.v26i6.10American Academy of Orthopedic Surgeons.Knee arthroscopy.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bhan K.Meniscal tears: current understanding, diagnosis, and management.Cureus. 2020;12(6). doi:10.7759/cureus.8590American Academy of Orthopaedic Surgeons.Meniscus tears.Duong TD, Tran DT, Do BNT, Tran HT, Le SM, Vu TT.Diagnostic value of clinical tests and Mri for meniscal injury in patients with anterior cruciate ligament injury: case series study.Int J Surg Case Rep.2021;88:106491. doi:10.1016/j.ijscr.2021.106492Blyth M, Anthony I, Francq B, et al.Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley’s, McMurray’s and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis.Health Technol Assess.2015 Aug;19(62):1-62. doi:10.3310/hta19620Gupta Y, Mahara D, Lamichhane A.McMurray’s test and joint line tenderness for medial meniscus tear: are they accurate?Ethiop J Health Sci. 2016;26(6):567-572. doi:10.4314/ejhs.v26i6.10American Academy of Orthopedic Surgeons.Knee arthroscopy.
Bhan K.Meniscal tears: current understanding, diagnosis, and management.Cureus. 2020;12(6). doi:10.7759/cureus.8590
American Academy of Orthopaedic Surgeons.Meniscus tears.
Duong TD, Tran DT, Do BNT, Tran HT, Le SM, Vu TT.Diagnostic value of clinical tests and Mri for meniscal injury in patients with anterior cruciate ligament injury: case series study.Int J Surg Case Rep.2021;88:106491. doi:10.1016/j.ijscr.2021.106492
Blyth M, Anthony I, Francq B, et al.Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley’s, McMurray’s and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis.Health Technol Assess.2015 Aug;19(62):1-62. doi:10.3310/hta19620
Gupta Y, Mahara D, Lamichhane A.McMurray’s test and joint line tenderness for medial meniscus tear: are they accurate?Ethiop J Health Sci. 2016;26(6):567-572. doi:10.4314/ejhs.v26i6.10
American Academy of Orthopedic Surgeons.Knee arthroscopy.
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