In-Depth Oral Presentations and Oral Communications IN-DEPTH ORAL PRESENTATIONS A01–ARTHROSCOPY Comparative analysis between clinical tests and arthroscopic investigation in meniscal tears associated with anterior cruciate ligament injury

Introduction The combined meniscus and anterior cruciate ligament (ACL) tears are commonly reported sport-contact injuries of the knee. The clinical maneuvers more adopted for identifying the meniscus injuries are McMurray test, Apley test, medial and lateral joint lines tenderness (JLT). The purpose of our study is that to evaluate the correlation between clinical examination and arthroscopic findings in associated acute meniscus and ACL injuries. Materials and methods One hundred and thirty seven patients with a mean age of 28.5 years (from 12 to 55), out of one hundred and seventy initially included, were retrospectively examined for acute ACL and meniscus traumatic injuries (from 6 to 8 weeks by the trauma), between March and November 2012 at our department. Clinical examination included McMurray test, Apley test and medial and lateral JLT. Then, the clinical tests were compared to the arthroscopic findings in order to estimate their sensitivity, specificity, accuracy, and lastly their positive and negative predictive value. Results We had found that the Apley test achieved a sensitivity of 51 and 48 %, a specificity of 84 and 79 % for medial and lateral meniscus tears, respectively. The McMurray test reached a sensitivity of 75 and 68 % while the specificity was 76 and 61 % for medial and lateral meniscus tears, respectively. The medial JLT had a sensitivity of 77 and 58 % and a specificity of 66 and 52 % for medial and lateral meniscus tears, respectively. Lastly, the lateral JLT achieved a sensitivity of 39 and 40 % and a specificity of 84 and 83 % for medial and lateral meniscus tears, respectively. Focusing on the accuracy, for the McMurray test it was 76 and 64 %, while for the Apley test it was 70 and 68 % in medial and lateral meniscus tears, respectively. Discussion We had demonstrated that the accuracy of the clinical examination is reduced in associated meniscus and ACL tears. However, the clinical tests achieved a sensitivity and a specificity as those reported by scientific evidence using MRI. Conclusions The associated meniscus and ACL injuries decrease the accuracy of the clinical tests for identifying the meniscus tears. The clinical tests can provide diagnosis of high suspicious, bypassing second level investigation, such as MRI, which cannot guarantee a better accuracy. Arthroscopic investigation remains the gold standard for diagnosis of the meniscus tears.