Ege's Test: Difference between revisions
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== Definition/Description == | == Definition/Description == | ||
The purpose of the test is to detect a meniscus tear. It’s also called the weight-bearing Mc Murray test because when patients perform this test, they have to put weight on their knees. Depending on the meniscus we want to investigate, the patient’s feet are turned outwards (medial meniscus) or inwards (lateral meniscus). <br> | The purpose of the test is to detect a meniscus tear. It’s also called the weight-bearing Mc Murray test because when patients perform this test, they have to put weight on their knees. Depending on the meniscus we want to investigate, the patient’s feet are turned outwards (medial meniscus) or inwards (lateral meniscus). <ref name="Akseki">D Akseki, O Ozcan, H Boya, and H Pinar. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Arthroscopy, The Journal of Arthroscopic & Related Surgery; Nov 2004; 20(9): 951-958.</ref><br> | ||
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== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
Revision as of 17:38, 18 May 2011
Original Editors - Van Horebeek Erika
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Search Strategy[edit | edit source]
Databases: Pubmed
Keywords:
- Ege’s test
- Meniscus tears
- Meniscus AND Ege’s test
Databases: PEDro
Keywords:
- Ege’s test
- Meniscus tears
- Meniscus AND Ege’s test
Definition/Description[edit | edit source]
The purpose of the test is to detect a meniscus tear. It’s also called the weight-bearing Mc Murray test because when patients perform this test, they have to put weight on their knees. Depending on the meniscus we want to investigate, the patient’s feet are turned outwards (medial meniscus) or inwards (lateral meniscus). [1]
Clinically Relevant Anatomy[edit | edit source]
Art. Genus consists of a number of anatomical structures and the menisci are a part of those structures. We have two menisci, a lateral and a medial. These cover the tibial articular surfaces.
The medial meniscus is larger than the lateral meniscus and has a C shape. This will combine with the Lig. Collaterale Mediale.
The lateral meniscus is smaller than the medial meniscus and has an O-shape. This is more mobile than the medial meniscus and will combine with the M. Popliteus [2]
Purpose
[edit | edit source]
The purpose of the test is to detect a Meniscus tear on the medial or lateral side of the knee. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Technique
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The test is performed with the patient in a standing position. At the beginning of the test, the knees are in extension and the feet are held 30 to 40 cm away from each other. For medial meniscus tears, the patient squats with both lower legs in maximum external rotation and then stands up slowly. The distance between the knees increases and each knee becomes externally rotated as the squatting proceeds. 1, 2, 3, 4 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
To detect a lateral meniscus tear, both lower extremities are held in maximum internal rotation while the patient squats and stands up. A complete squat in full internal rotation is rarely possible, even for healthy knees, therefore the patient is allowed to steady themselves for a slightly less than full squat. In contrast to the medial meniscus test, the distance between the knees decreases and the knees become internally rotated as the squatting proceeds. 1, 2, 3, 4 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The test is positive when pain and/or a click is felt by the patient at the related site of the joint line. Further squatting is stopped as soon as the pain and/or click is felt. Hereby a full squat is not needed in all of the patients. Sometimes pain and/or click may not be felt until maximum squat, but may be felt as the patient comes out of the squat, which is also a positive sign of the test. Pain and/or click are felt at around 90° of knee flexion. 1, 2, 3, 4, 5, 6 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Anteriorly located tears produce the symptoms in earlier knee flexion, whereas tears located on posterior horn of the menisci produce the symptoms in more knee flexion.
Flexion-extension, and internal-external rotation components of the test are similar to that of McMurray’s test. However, the most important difference is the weight-bearing position of the patient. The test may also be called the weight-bearing McMurray’s test. Varus and valgus stress is also produced during internal and external rotation positions. 1Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
image:
(A) To detect a medial meniscal tear, both lower extremities are held in maximum external rotation.
(B) The patient then squats in this position.
(C) For lateral meniscal tears, both lower extremities are held in maximum internal rotation.
(D) Maximum internal rotations of both lower extremities are preserved during squatting.
Evidence
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| N (Akseki et al.) |
effected side |
accuracy |
sensitivity |
specificity |
pos. liklihood |
neg. likelihood |
total % of wrong predictions |
|---|---|---|---|---|---|---|---|
| 211 |
med |
0,71 |
0,67 |
0,81 |
3,5 |
0,4 |
26% |
| lat |
0,84 |
0,64 |
0,90 |
5,3 |
0,5 |
21% | |
| M = 24% ± 2,55 |
1, 3, 5 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
According to Akseki et al. (B) the test correlated well to arthroscopic findings with a 0,341 kappa score. Akseki et al. compared diagnostic values of the Ege’s test with McMurray’s test and joint line tenderness. There were no statistically significant differences found between the 3 tests in detecting a meniscus tear ( p > 0,05). However, for medial meniscus tears, Ege’s test scored better accuracy, sensitivity, and specificity rates with respectively 0,71, 0,67 and 0,81. For lateral meniscus tears Ege's test gave results superior to the others: 0,84 accuracy, 0,64 sensitivity and 0,90 specificity. Ege’s test is more specific than sensitive. 1 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Looking at the different types of meniscal tears, Akseki et al. found that degenerative tears of the medial menisci were missed in 66% (8 of 12!). Medial menisci were diagnosed correctly with Ege’s test in 84% of cases, compared to only 61% with McMurray’s test. Similarly, Ege’s test was better at diagnosing longitudinal and bucket-handle medial meniscal tears. 1Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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References[edit | edit source]
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- ↑ D Akseki, O Ozcan, H Boya, and H Pinar. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Arthroscopy, The Journal of Arthroscopic & Related Surgery; Nov 2004; 20(9): 951-958.
- ↑ McKeon B, Bono J, Richmond J. Knee Arthroscopy. Springer; 2009: 202 (1, 2, 12, 43)
