{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:55:06Z","timestamp":1790420106832,"version":"4.1.0"},"reference-count":37,"publisher":"National Institute for Health and Care Research","issue":"62","license":[{"start":{"date-parts":[[2015,8,1]],"date-time":"2015-08-01T00:00:00Z","timestamp":1438387200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["09\/163\/02"],"award-info":[{"award-number":["09\/163\/02"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"Background<\/jats:title>Reliable non-invasive diagnosis of meniscal tears is difficult. Magnetic resonance imaging (MRI) is often used but is expensive and incidental findings are problematic. There are a number of physical examination tests for the diagnosis of meniscal tears that are simple, cheap and non-invasive.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To determine the diagnostic accuracy of the Thessaly test and to determine if the Thessaly test (alone or in combination with other physical tests) can obviate the need for further investigation by MRI or arthroscopy for patients with a suspected meniscal tear.<\/jats:p><\/jats:sec>Design<\/jats:title>Single-centre prospective diagnostic accuracy study.<\/jats:p><\/jats:sec>Setting<\/jats:title>Although the study was performed in a secondary care setting, it was designed to replicate the results that would have been achieved in a primary care setting.<\/jats:p><\/jats:sec>Participants<\/jats:title>Two cohorts of patients were recruited: patients with knee pathology (n<\/jats:italic>\u2009=\u2009292) and a control cohort with no knee pathology (n<\/jats:italic>\u2009=\u200975).<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Sensitivity, specificity and diagnostic accuracy of the Thessaly test in determining the presence of meniscal tears.<\/jats:p><\/jats:sec>Methods<\/jats:title>Participants were assessed by both a primary care clinician and a musculoskeletal clinician. Both clinicians performed the Thessaly test, McMurray\u2019s test, Apley\u2019s test, joint line tenderness test and took a standardised clinical history from the patient.<\/jats:p><\/jats:sec>Results<\/jats:title>The Thessaly test had a sensitivity of 0.66, a specificity of 0.39 and a diagnostic accuracy of 54% when utilised by primary care clinicians. This compared with a sensitivity of 0.62, a specificity of 0.55 and diagnostic accuracy of 59% when used by musculoskeletal clinicians. The diagnostics accuracy of the other tests when used by primary care clinicians was 54% for McMurray\u2019s test, 53% for Apley\u2019s test, 54% for the joint line tenderness test and 55% for clinical history. For primary care clinicians, age and past history of osteoarthritis were both significant predictors of MRI diagnosis of meniscal tears. For musculoskeletal clinicians age and a positive diagnosis of meniscal tears on clinical history taking were significant predictors of MRI diagnosis. No physical tests were significant predictors of MRI diagnosis in our multivariate models. The specificity of MRI diagnosis was tested in subgroup of patients who went on to have a knee arthroscopy and was found to be low [0.53 (95% confidence interval 0.28 to 0.77)], although the sensitivity was 1.0.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The Thessaly test was no better at diagnosing meniscal tears than other established physical tests. The sensitivity, specificity and diagnostic accuracy of all physical tests was too low to be of routine clinical value as an alternative to MRI. Caution needs to be exercised in the indiscriminate use of MRI scanning in the identification of meniscal tears in the diagnosis of the painful knee, due to the low specificity seen in the presence of concomitant knee pathology. Further research is required to determine the true diagnostic accuracy and cost-effectiveness of MRI for the detection of meniscal tears.<\/jats:p><\/jats:sec>Trial registration<\/jats:title>Current Controlled Trial ISRCTN43527822.<\/jats:p><\/jats:sec>Funding<\/jats:title>The National Institute for Health Research Health Technology Assessment programme.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta19620","type":"journal-article","created":{"date-parts":[[2015,8,5]],"date-time":"2015-08-05T09:34:52Z","timestamp":1438767292000},"page":"1-62","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley\u2019s, McMurray\u2019s and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis"],"prefix":"10.3310","volume":"19","clinical-trial-number":[{"clinical-trial-number":"isrctn43527822","registry":"10.18810\/isrctn","type":"results"}],"author":[{"given":"Mark","family":"Blyth","sequence":"first","affiliation":[{"name":"Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain","family":"Anthony","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Francq","sequence":"additional","affiliation":[{"name":"Robertson Centre for Biostatistics, Glasgow University, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katriona","family":"Brooksbank","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Downie","sequence":"additional","affiliation":[{"name":"Muirside Medical Practice, Baillieston Health Centre, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Powell","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryn","family":"Jones","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus","family":"MacLean","sequence":"additional","affiliation":[{"name":"Orthopaedic Research Unit, Glasgow Royal Infirmary, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"McConnachie","sequence":"additional","affiliation":[{"name":"Robertson Centre for Biostatistics, Glasgow University, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Norrie","sequence":"additional","affiliation":[{"name":"Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2015,8]]},"reference":[{"key":"key20150805102237789_ref1-bib1","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1046\/j.1469-7580.1998.19320161.x","article-title":"The menisci of the knee joint. Anatomical and functional characteristics, and a rationale for clinical treatment","volume":"193","author":"Messner","year":"1998","journal-title":"J Anat"},{"key":"key20150805102237789_ref1-bib2","doi-asserted-by":"crossref","first-page":"168","DOI":"10.5435\/00124635-200205000-00003","article-title":"Meniscal injury: I. Basic science and evaluation","volume":"10","author":"Greis","year":"2002","journal-title":"J Am Acad Orthop Surg"},{"key":"key20150805102237789_ref1-bib3","doi-asserted-by":"publisher","first-page":"45","DOI":"10.2147\/OAJSM.S7753","article-title":"Meniscal tears","volume":"1","author":"Maffulli","year":"2010","journal-title":"Open Access J Sports Med"},{"key":"key20150805102237789_ref1-bib4","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1177\/036354658201000205","article-title":"Microvasculature of the human meniscus","volume":"10","author":"Arnoczky","year":"1982","journal-title":"Am J Sports Med"},{"key":"key20150805102237789_ref1-bib5","first-page":"10","article-title":"The meniscal healing process","volume":"2","author":"de Albornoz","year":"2012","journal-title":"Muscles Ligaments Tendons J"},{"key":"key20150805102237789_ref1-bib6","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1177\/1941738111429419","article-title":"The basic science of human knee menisci: structure, composition, and function","volume":"4","author":"Fox","year":"2012","journal-title":"Sports Health"},{"key":"key20150805102237789_ref1-bib7","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.knee.2006.01.005","article-title":"Epidemiology of athletic knee injuries: a 10-year study","volume":"13","author":"Majewski","year":"2006","journal-title":"Knee"},{"key":"key20150805102237789_ref1-bib8","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1016\/S0749-8063(98)70018-0","article-title":"Clinical results of meniscus repair in patients 40 years and older","volume":"14","author":"Barrett","year":"1998","journal-title":"Arthroscopy"},{"key":"key20150805102237789_ref1-bib9","doi-asserted-by":"publisher","first-page":"4048","DOI":"10.1002\/art.23071","article-title":"Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness","volume":"56","author":"Englund","year":"2007","journal-title":"Arthritis Rheum"},{"key":"key20150805102237789_ref1-bib10","doi-asserted-by":"publisher","first-page":"2178","DOI":"10.1002\/art.11088","article-title":"Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls","volume":"48","author":"Englund","year":"2003","journal-title":"Arthritis Rheum"},{"key":"key20150805102237789_ref1-bib11","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1002\/art.21724","article-title":"The association of meniscal pathologic changes with cartilage loss in symptomatic knee osteoarthritis","volume":"54","author":"Hunter","year":"2006","journal-title":"Arthritis Rheum"},{"key":"key20150805102237789_ref1-bib12","first-page":"776","article-title":"Meniscal tear as an osteoarthritis risk factor in a largely non-osteoarthritic cohort: a cross-sectional study","volume":"34","author":"Ding","year":"2007","journal-title":"J Rheumatol"},{"key":"key20150805102237789_ref1-bib13","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1056\/NEJMoa0800777","article-title":"Incidental meniscal findings on knee MRI in middle-aged and elderly persons","volume":"359","author":"Englund","year":"2008","journal-title":"N Engl J Med"},{"key":"key20150805102237789_ref1-bib14","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1302\/0301-620X.84B7.13637","article-title":"Complications of arthroscopy of the knee","volume":"84","author":"Allum","year":"2002","journal-title":"J Bone Joint Surg Br"},{"key":"key20150805102237789_ref1-bib15","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/S0749-8063(85)80086-4","article-title":"Complications of arthroscopy and arthroscopic surgery: results of a national survey. Committee on Complications of Arthroscopy Association of North America","volume":"1","author":"DeLee","year":"1985","journal-title":"Arthroscopy"},{"key":"key20150805102237789_ref1-bib16","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/0749-8063(92)90039-E","article-title":"Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors","volume":"8","author":"Armstrong","year":"1992","journal-title":"Arthroscopy"},{"key":"key20150805102237789_ref1-bib17","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1093\/bmb\/ldm022","article-title":"Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review","volume":"84","author":"Crawford","year":"2007","journal-title":"Br Med Bull"},{"key":"key20150805102237789_ref1-bib18","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1148\/radiol.2263011892","article-title":"MR imaging of the menisci and cruciate ligaments: a systematic review","volume":"226","author":"Oei","year":"2003","journal-title":"Radiology"},{"key":"key20150805102237789_ref1-bib19","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/j.rdc.2009.08.004","article-title":"The meniscus in knee osteoarthritis","volume":"35","author":"Englund","year":"2009","journal-title":"Rheum Dis Clin North Am"},{"key":"key20150805102237789_ref1-bib20","doi-asserted-by":"crossref","first-page":"4","DOI":"10.2106\/00004623-200301000-00002","article-title":"The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee","volume":"85","author":"Bhattacharyya","year":"2003","journal-title":"J Bone Joint Surg Am"},{"key":"key20150805102237789_ref1-bib21","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1148\/radiol.2393050253","article-title":"Osteoarthritis of the knee: association between clinical features and MR imaging findings","volume":"239","author":"Kornaat","year":"2006","journal-title":"Radiology"},{"key":"key20150805102237789_ref1-bib22","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1016\/j.arthro.2004.06.008","article-title":"The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture","volume":"20","author":"Kocabey","year":"2004","journal-title":"Arthroscopy"},{"key":"key20150805102237789_ref1-bib23","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1758-2555-3-25","article-title":"Clinical examination of the knee: know your tools for diagnosis of knee injuries","volume":"3","author":"Rossi","year":"2011","journal-title":"Sports Med Arthrosc Rehabil Ther Technol"},{"key":"key20150805102237789_ref1-bib24","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/0749-8063(89)90168-0","article-title":"The predictive value of five clinical signs in the evaluation of meniscal pathology","volume":"5","author":"Fowler","year":"1989","journal-title":"Arthroscopy"},{"key":"key20150805102237789_ref1-bib25","doi-asserted-by":"publisher","first-page":"955","DOI":"10.2106\/JBJS.D.02338","article-title":"Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears","volume":"87","author":"Karachalios","year":"2005","journal-title":"J Bone Joint Surg Am"},{"key":"key20150805102237789_ref1-bib26","doi-asserted-by":"publisher","first-page":"541","DOI":"10.2519\/jospt.2007.2560","article-title":"Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis","volume":"37","author":"Hegedus","year":"2007","journal-title":"J Orthop Sports Phys Ther"},{"key":"key20150805102237789_ref1-bib27","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/JSM.0b013e31818f1689","article-title":"The Thessaly test for detection of meniscal tears: validation of a new physical examination technique for primary care medicine","volume":"19","author":"Harrison","year":"2009","journal-title":"Clin J Sport Med"},{"key":"key20150805102237789_ref1-bib28","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1007\/s00167-009-0803-3","article-title":"Do physical diagnostic tests accurately detect meniscal tears?","volume":"17","author":"Konan","year":"2009","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"key20150805102237789_ref1-bib29","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.knee.2009.08.007","article-title":"Validation of the Thessaly test for detecting meniscal tears in anterior cruciate deficient knees","volume":"17","author":"Mirzatolooei","year":"2010","journal-title":"Knee"},{"key":"key20150805102237789_ref1-bib30","first-page":"78","article-title":"The diagnosis of meniscus injuries; some new clinical methods","volume":"29","author":"Apley","year":"1947","journal-title":"J Bone Joint Surg Am"},{"key":"key20150805102237789_ref1-bib31","first-page":"319","article-title":"Anatomy and physical examination of the knee menisci: a narrative review of the orthopedic literature","volume":"53","author":"Chivers","year":"2009","journal-title":"J Can Chiropr Assoc"},{"key":"key20150805102237789_ref1-bib32","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological assessment of osteo-arthrosis","volume":"16","author":"Kellgren","year":"1957","journal-title":"Ann Rheum Dis"},{"key":"key20150805102237789_ref1-bib33","volume-title":"The Musculoskeletal Services Framework","author":"Department of Health","year":"2006"},{"key":"key20150805102237789_ref1-bib34","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.arthro.2013.12.016","article-title":"Efficacy of magnetic resonance imaging evaluation for meniscal tear in acute anterior cruciate ligament injuries","volume":"30","author":"Nam","year":"2014","journal-title":"Arthroscopy"},{"key":"key20150805102237789_ref1-bib35","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1177\/1941738111434396","article-title":"Accuracy of magnetic resonance imaging of the knee in the community setting","volume":"4","author":"Hardy","year":"2012","journal-title":"Sports Health"},{"key":"key20150805102237789_ref1-bib36","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s00264-006-0131-x","article-title":"Reliability of clinical diagnosis in meniscal tears","volume":"31","author":"Mohan","year":"2007","journal-title":"Int Orthop"},{"key":"key20150805102237789_ref1-bib37","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1007\/s00167-011-1636-4","article-title":"History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions","volume":"20","author":"Ercin","year":"2012","journal-title":"Knee Surg Sports Traumatol Arthrosc"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta19620\/hta19620.xml","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2002262","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta19620\/hta19620.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2002748","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T15:35:32Z","timestamp":1692113732000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/hta19620\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,8]]},"references-count":37,"journal-issue":{"issue":"62","published-online":{"date-parts":[[2015,8]]}},"alternative-id":["10.3310\/hta19620"],"URL":"https:\/\/doi.org\/10.3310\/hta19620","relation":{},"ISSN":["1366-5278","2046-4924"],"issn-type":[{"value":"1366-5278","type":"print"},{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,8]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"}]}}