Influence of Concomitant Articular Cartilage Injury on the Diagnostic Performance of Physical Examination Tests for...

Meniscal tears are common knee injuries that frequently coexist with articular cartilage damage. Although physical examination remains essential for clinical diagnosis, the diagnostic performance of meniscal tests may be influenced by concomitant cartilage injury.

To investigate whether articular cartilage injury affects the diagnostic performance of the McMurray test and joint line tenderness for meniscal tears, including traumatic and degenerative lesions.

Cohort Study (Diagnosis); Level of evidence, 3.

A total of 186 knees from 179 consecutive patients who underwent an arthroscopic evaluation were retrospectively analyzed. Physical examination findings, including the McMurray test and joint line tenderness, were compared with arthroscopically confirmed meniscal tears. Articular cartilage injury was defined as an International Cartilage Repair Society grade ≥2. The diagnostic performance was evaluated in knees with and without concomitant cartilage injury. Logistic regression analysis was used to evaluate interactions between physical examination findings and cartilage status.

Medial meniscal tears were identified in 91 knees and lateral meniscal tears in 86 knees, including 9 knees with combined tears. Articular cartilage injury was present in 109 knees, including 18 without meniscal tears. Cartilage injury was associated with older age (P < .001), patellar ballottement (P = .019), and medial joint line tenderness (P = .022). In the overall cohort, joint line tenderness showed high sensitivity for medial and lateral meniscal tears (80.2% and 73.3%, respectively), whereas the McMurray test showed high specificity (91.4% and 91.2%, respectively). Similar diagnostic patterns were observed in knees without concomitant cartilage injury. In adjusted analyses, the McMurray test was not significantly affected by cartilage injury in either compartment (medial, P = .667; lateral, P = .064). However, medial joint line tenderness showed significantly reduced diagnostic performance in the presence of medial compartment cartilage injury (odds ratio [OR], 0.10; P = .027).

The diagnostic performance of the McMurray test for meniscal tears appears largely preserved regardless of concomitant articular cartilage injury. However, medial joint line tenderness may demonstrate a reduced diagnostic performance in the presence of medial compartment cartilage injury, suggesting that palpation-based findings should be interpreted with caution.