Konan Sujith, Rayan Faizal, Haddad Fares Sami
University College Hospital, 25 Grafton Way, London, WC1E 6AA, UK.
Knee Surg Sports Traumatol Arthrosc. 2009 Jul;17(7):806-11. doi: 10.1007/s00167-009-0803-3. Epub 2009 Apr 28.
Numerous physical tests have been described but their diagnostic accuracy is often questioned. Karachalios et al. described the new 'Thessaly test' and concluded that it could be safely used as a first line screening test for the selection of patients who need arthroscopic meniscal surgery. Our objective was to study the role of physical diagnostic tests in screening for meniscal tears and to validate the diagnostic accuracy of the Thessaly test. We examined 109 patients (80 male, 29 female; average age: 39 years; range: 16-56) who were presented with a history suggestive of a meniscal tear. Joint line tenderness, McMurray's test, and the Thessaly test were assessed by an independent investigator blinded to any imaging data in all patients. MRI and subsequent arthroscopy results were then collated. Our study showed a much lower diagnostic accuracy for the Thessaly test (61% for medial meniscus and 80% for lateral meniscus). It is comparable to McMurray's test (57% for medial meniscus and 77% for lateral meniscus). The Joint line tenderness test has a far superior diagnostic accuracy (81% for medial meniscus and 90% for lateral meniscus). However, combining the joint line tenderness test with McMurray's test or the joint line tenderness test with Thessaly test further increased the accuracy of physical diagnosis of meniscal tears. Magnetic resonance imaging (MRI) detected 96% of meniscal tears. Physical tests may not always be diagnostic of meniscal tears. MRI and arthroscopy may be essential in dubious clinical presentations and especially where more than one pathology is suspected. Our study showed that the Thessaly test in isolation was not useful for the detection of meniscal tears but it helps to increase diagnostic certainty when combined with other standard tests.
已有众多体格检查方法被描述,但它们的诊断准确性常常受到质疑。卡拉查利奥斯等人描述了新的“塞萨利试验”,并得出结论,该试验可安全地用作一线筛查试验,以筛选出需要进行关节镜半月板手术的患者。我们的目的是研究体格诊断检查在半月板撕裂筛查中的作用,并验证塞萨利试验的诊断准确性。我们检查了109例患者(80例男性,29例女性;平均年龄:39岁;范围:16 - 56岁),这些患者均有提示半月板撕裂的病史。由一名对所有患者的任何影像数据均不知情的独立研究者对关节线压痛、麦克马瑞试验和塞萨利试验进行评估。然后整理MRI及随后的关节镜检查结果。我们的研究显示,塞萨利试验的诊断准确性要低得多(内侧半月板为61%,外侧半月板为80%)。它与麦克马瑞试验相当(内侧半月板为57%,外侧半月板为77%)。关节线压痛试验的诊断准确性要高得多(内侧半月板为81%,外侧半月板为90%)。然而,将关节线压痛试验与麦克马瑞试验相结合,或将关节线压痛试验与塞萨利试验相结合,可进一步提高半月板撕裂体格诊断的准确性。磁共振成像(MRI)检测出96%的半月板撕裂。体格检查可能并不总能诊断出半月板撕裂。在可疑的临床表现中,尤其是怀疑存在多种病变时,MRI和关节镜检查可能至关重要。我们的研究表明,单独的塞萨利试验对半月板撕裂的检测并无用处,但与其他标准检查相结合时,它有助于提高诊断的确定性。