Hing Wayne, White Steve, Reid Duncan, Marshall Rob
J Man Manip Ther. 2009;17(1):22-35. doi: 10.1179/106698109790818250.
Clinical assessment of meniscal pathology in the knee has proven difficult due to the wide number of tests available and variations in their interpretation and application. The purpose of this paper was to assess the literature investigating the validity and diagnostic accuracy of the McMurray's test (and modifications) for determining meniscal pathology of the knee so that conclusions could be drawn regarding its clinical usefulness as a test. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. In addition, cited references of relevant articles were examined. Studies were included for analysis if they compared the McMurray's test with a gold standard of knee arthroscopy or magnetic resonance imaging (MRI). Eleven studies met the inclusion criteria. Collectively, these studies indicate that there is little consensus in the reported measures of validity of the McMurray's test and that this is mostly due to limitations in the methodological quality of the studies that were assessed. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. Generally, the McMurray's test has relatively high specificity and low sensitivity. The studies that compared the diagnostic accuracy of the McMurray's test with that of modified versions of the test showed enhanced diagnostic accuracy for the modified tests. This review identified that the McMurray's test is of limited clinical value due to relatively low sensitivity, with modified tests (associated with the traditional McMurray's test) having higher diagnostic accuracy and thus these may be more useful clinically.
由于可用于评估膝关节半月板病变的检查方法众多，且在解读和应用上存在差异，膝关节半月板病变的临床评估一直颇具难度。本文旨在评估研究麦克马瑞试验（及其改良方法）用于判定膝关节半月板病变的有效性和诊断准确性的文献，以便就其作为一项检查的临床实用性得出结论。检索了1980年3月至2008年5月的电子数据库（医学索引数据库、护理学与健康领域数据库、联合与补充医学数据库、体育与运动医学数据库以及Scopus数据库）。此外，还查阅了相关文章的参考文献。若研究将麦克马瑞试验与膝关节镜检查或磁共振成像（MRI）的金标准进行比较，则纳入分析。共有11项研究符合纳入标准。总体而言，这些研究表明，在报道的麦克马瑞试验有效性测量方面几乎没有共识，这主要是由于所评估研究的方法学质量存在局限性。采用诊断准确性报告标准（STARD）得出的方法学评分在10/25至20/25之间。一般来说，麦克马瑞试验具有相对较高的特异性和较低的敏感性。将麦克马瑞试验与该试验改良版本的诊断准确性进行比较的研究表明，改良试验的诊断准确性有所提高。本综述发现，由于敏感性相对较低，麦克马瑞试验的临床价值有限，而改良试验（与传统麦克马瑞试验相关）具有更高的诊断准确性，因此在临床上可能更有用。
