McMurray, JLT and Apley's tests shown to have poor diagnostic accuracy .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):303 J Orthop Sports Phys Ther. 2007 Sep;37(9):541-50This systematic review with meta-analysis identified 18 studies that investigated the diagnostic accuracy of 3 physical examination tests in detecting a torn tibial meniscus. Fourteen of these studies evaluated McMurray's test, 14 examined joint line tenderness, and 7 examined Apley's test. The results from this analysis conclude that the McMurray, JLT and Apley's test have poor diagnostic accuracy when analyzing torn tibial menisci.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Introduction
3/4
Accessing Data
4/4
Analysing Data
3/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
The life-time prevalence of knee pain can be up to 45%. General practitioners must decide whether an individual will need conservative treatment or requires surgery and the use of physical examination tests are typically what makes this decision. There is much uncertainty as to the ability that physical examination tests have in diagnosing a torn meniscus. Due to the limited recent evidence regarding the diagnostic accuracy of these special tests, this systematic review and meta-analysis was completed.
¿Cuál era la pregunta principal de la investigación?
Which physical examination tests (if any) are accurate at detecting and diagnosing a torn tibial meniscus?
- McMurray's test had a pooled sensitivity of 70.5 (95% CI: 67.4 to 73.4) and a pooled specificity of 71.1 (95% CI: 69.3 to 72.9).
- The pooled sensitivity of the JLT was 63.3 (95% CI: 60.9 to 65.7) and the pooled specificity was 77.4 (95% CI: 75.6 to 79.1).
- Apley's test had a pooled sensitivity of 60.7 (95% CI: 55.7 to 65.5) and a pooled specificity of 70.2 (95% CI: 68.0 to 72.4).
- There was significant statistical heterogeneity for all 3 tests evidenced by a significant P value for the Cochran Q test (P[Q]<0.01), however the I squared statistic for McMurray's, JLT and Apley's test (79%, 87%, 75%, respectively) indicated that none of these tests had discriminative power in diagnosing a torn tibial meniscus.
¿Qué es lo que más debo recordar?
This study concludes that the McMurray, JLT and Apley's test have poor diagnostic accuracy, in detecting a torn tibial meniscus. However, it is important to note that these are not firm conclusions due to the heterogeneity and insufficient quality of the studies.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this study indicate that the McMurray, JLT and Apley's tests are not of great diagnostic quality in the detection of a torn tibial meniscus. Future high quality trials are required to assess these tests and what possible tests can provide accurate detection of meniscal tears.
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