Clinical diagnosis of meniscal tears. Description of a new manipulative test.

The accuracy in clinical diagnosis of meniscal tears was assessed in 100 knees. Arthroscopy was performed in each case to establish the diagnosis. The clinical diagnosis was correct in 87 cases, correct but incomplete in 4, and incorrect in 9. In those with meniscal tears repeated popping occurred in 43%, swelling in 51%, and pain localized to the joint line in 63%. Tenderness over the joint line, the most accurate clinical sign, was positive in 77% and false positive in 11% of meniscal tears. McMurray's test was positive in 58% and false positive in 5%, while the medial-lateral grind test was positive in 68% and false positive in 1%. At least one of these manipulative tests was positive in 79% of meniscal tears. Repeated examination and addition of the medial-lateral grind test to the clinical evaluation of meniscal tears significantly improves diagnostic accuracy.