For knee pain, how predictive is physical examination for meniscal injury?

Abstract

No single clinical examination element, or combination of such elements, reliably detects meniscal injury. The McMurray test is best for ruling in meniscal pathology. Assuming a 9% prevalence of meniscal tears among all knee injuries (a rate reflecting national primary care data), the posttest probability that a patient with McMurray's sign has a meniscal injury ranges from <30% to 63% (strength of recommendation [SOR]: B). In contrast, the absence of any positive physical examination findings effectively rules out meniscal pathology, yielding a posttest probability of 0.8% for lateral meniscus injury, 1.0% for medial meniscus injury, and 3.8% for any meniscal injury among primary care populations (SOR: B).