The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee - A meta-analysis

OBJECTIVE Our systematic review summarizes die evidence about the accuracy of physical diagnostic tests for assessing meniscal lesions of the knee. SEARCH STRATEGY We performed a literature search of MEDLINE (1966-1999) and EMBASE (1988-1999) with additional reference tracking. SELECTION CRITERIA Articles written in English, French, German, or Dutch th at addressed the accuracy of at least one physical diagnostic test for meni scus injury with arthrotomy, arthroscopy, or magnetic resonance imaging as the gold standard were included. DATA COLLECTION AND ANALYSIS Two reviewers independently selected studies, assessed the methodologic quality, and abstracted data using a standardized protocol. MAIN RESULTS Thirteen studies (of 402) met the inclusion criteria. The resu lts of the index and reference tests, were assessed independently (blindly) of each other in only 2 studies, and in all studies verification bias seem ed to be present. The study results were highly heterogeneous. The summary receiver operating characteristic curves of the assessment of joint effusio n, the McMurray test, and joint line tenderness indicated little discrimina tive power for these tests. Only the predictive Value of a positive McMurra y test was favorable. CONCLUSIONS The methodologic quality of studies addressing the diagnostic a ccuracy of meniscal tests was poor, and the results were highly heterogeneo us. The poor characteristics indicate that these tests are of little value for clinical practice.