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Validity of the McMurray Test for Meniscal Tear in Pediatric and Adolescent Patients
Natalya Sarkisova1, Laura DeGuzman1, Tishya A L Wren1
1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, California; and.
Objective:
The aim of this study was to identify the accuracy of the McMurray test in the adolescent and pediatric population.
Design:
Retrospective case series.
Setting:
Tertiary care, institutional.
Patients:
Inclusion criteria included patients who presented with unilateral knee pain and were seen by pediatric sports medicine physicians. Patients were excluded if their knee pain was related to any underlying conditions. Three hundred patient charts were reviewed, and 183 patients (age range: 8-18 years, mean: 14 years; 74 male) met the inclusion criteria.
Interventions:
Symptoms at initial visit (knee pain).
Main Outcome Measures:
Presence of a meniscal tear using the McMurray test.
Results:
Eighty-four percent (160/191) of patients had a McMurray test documented as performed by the physician, and 17% (27/160) elucidated a positive response. Of 26 patients who had a positive McMurray and underwent magnetic resonance imaging (MRI), 16 (62%) showed a meniscal tear on their MRI. However, of the 87 patients who had a negative McMurray and still underwent MRI, 25 (29%) had a positive meniscal tear. The sensitivity, specificity, positive predictive value, and negative predictive value were 39%, 86%, 62%, and 71%, respectively.
Conclusion:
In a pediatric and adolescent population, the McMurray test was negative for 61% (23/38) of meniscal tears identified on MRI.
Clinical Relevance:
Although the test can be a useful tool as a part of a thorough evaluation, combining it with mechanical symptoms, patient history and imaging may be more helpful to diagnose a meniscus tear.
