Ege's Test

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Original Editors - Van Horebeek Erika

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Search Strategy

Database = PubMed

Keywords = Ege's test

Definition/Description

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Clinically Relevant Anatomy

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Purpose

The purpose of the test is to detect a meniscus tear 1, 2, 3, 4, 5, 6

Technique

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

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

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

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. 1

(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

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

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

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. 1

Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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1. Akseki D, Özcan Ö, Boya H, Pınar H. New Weight-Bearing Meniscal Test and a Comparison With McMurray’s Test and Joint Line Tenderness. Arthroscopy: The Journal of Arthroscopic and Related Surgery 2004; Vol 20; 9:951-958

2. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2007 Sep;37(9):541-50.

3. Hing W, White S, Reid D, Marshall R. Validity of the McMurray's Test and Modified Versions of the Test: A Systematic Literature Review. The Journal of Manual & Manipulative Therapy [2009, 17(1):22-35]

4. Manish Pruthi MS DNB, Ravi K Gupta MS DNB MNAMS FIMSA, Akshay Goel MS. Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India. Current concepts in meniscal injuries.

5. Daniel Bossen and Marcel Jurad. The Accuracy of Physical Examination Techniques in Diagnosing Meniscus Lesions. A Systematic Review

6. Dan Lorenz, MS, PT, ATC/L, CSCS, KPTA Research Committee Member. Literature Review: CLINICAL TESTS FOR MENISCUS LESIONS.