AN EXPLORATORY ASSESSMENT OF THE THESSALY TEST FOR DIAGNOSING A MENISCAL INJURY
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BACKGROUND: Injury-related musculoskeletal conditions are common in the military due to the young, active population (Hauret et al., 2010). Lower limb conditions constituted 55.8% of all referrals to a military RRU, 12% of which affected the knee (Strowbridge and Burgess, 2002). Meniscal injuries were the most prevalent diagnosis (Hayton, 2004). It is essential in the military environment that meniscal injuries are identified early and accurately, to allow early implementation of appropriate treatment, optimise recovery time and return to full operational fitness (Hayton, 2004). It has been suggested by Karachalios et al. (2005) that the Thessaly test significantly increased diagnostic accuracy of clinical examinations by reproducing the exact mechanism of injury in a dynamic, functional weight-bearing position. The aim of the present study was to identify whether the Thessaly test is more sensitive at detecting meniscal tears in comparison to other routine meniscal tests, using MRI as the gold standard It also aims to determine whether physiotherapists find the Thessaly test easy to perform and whether they will continue to integrate the Thessaly test into their routine assessment of suspected meniscal tears. METHOD: A diagnostic comparison study was undertaken within the military setting between January 2012 and January 2013. Data for this study was collected from RRUs across the UK. RRU clinicians identified subjects with a possible meniscal injury from the subjective history, mechanism of injury and provisional diagnosis from previous physiotherapists. All potential subjects with a suspicion of a meniscal tear who fulfilled the inclusion criteria were invited to take part in the study. Once informed consent had been obtained, the physiotherapist conducted a routine assessment of the subject’s knee and was asked to include the following meniscal tests; McMurray’s test, the JLT test and the Thessaly test. The subject was sent for an MRI scan and results were compared with results from the clinical tests. Sensitivity and specificity of each test was calculated. The McNemar 2 ×2 table was used to compare the results of each clinical test with MRI findings and the McNemar Χ2 test was used to analyse the statistical significance of the data. RESULTS: Sixty two subjects were sent for MRI scan 55 of which were thought to have a meniscal tear. Of these 55, 26 had meniscal lesions confirmed on MRI. The remaining 29 subjects had negative MRI scans for a meniscal lesion. These results identify a 95% confidence that the sensitivity of diagnosing a meniscal lesion is significantly greater when using the Thessaly test than McMurray’s test. However, this was the only statistically significant result as all other results for comparing sensitivity and specificity between the tests had a P value of > 0.05. CONCLUSION: Although the sensitivity of diagnosing a meniscal lesion is statistically greater when using the Thessaly test in comparison to McMurray’s test, meniscal tests still demonstrate poor diagnostic accuracy. A combination of history, mechanism of injury and thorough clinical examination using a combination of clinical tests is required to formulate an accurate diagnosis. A combination of tests used for diagnosing meniscal lesions improves sensitivity, specificity and diagnostic accuracy of the tests and has better predictive values.
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