Thessaly test

Purpose[edit | edit source]

Clinical screening tool for meniscal tears/ lesions.

Patients with suspected meniscal tears experience medial or lateral joint-line discomfort and may have a sense of locking or catching. The Thessaly test is a dynamic reproduction of joint loading in the knee and the theory behind the test is that the knee with a meniscal tear will produce the same symptoms the patient reported. [1]

Knee Joint.jpg[2]

Technique[edit | edit source]

The patient stands flat footed on one leg while the examiner supports the patient by holding their outstretched hands. The patient then flexes the knee to 5° and rotates the femur on the tibia medially and laterally three times, while maintaining the 5° flexion. The uninjured leg is tested first so that the patient may be trained with regard to how to keep the knee in the flexed position. The test is then repeated at 20° flexion. [1] The test is considered positive for a meniscus tear if the patient experiences medial or lateral joint line discomfort or a sense of locking/ catching in the knee.

Thessaly test video provided by Clinically Relevant

Evidence[edit | edit source]

In his original study from 2005, Karachalios [1] found the following statistics for his test: 
Thessaly Test at 5°

Sensitivity Specificity +LR -LR
Injury to Medial Meniscus 0.66 0.96 16.5 0.35
Injury to Lateral Meniscus 0.81 0.91 9 0.21
Combined Injury of ACL and Meniscus 0.65 0.83    -   -

Thessaly Test at 20° 

Sensitivity Specificity +LR -LR
Injury to Medial Meniscus 0.89 0.97 29.67 0.11
Injury to Lateral Meniscus 0.92 0.96 23 0.21
Combined Injury of ACL and Meniscus 0.80 0.91

In more recent studies [3][4][5] from 2015, the Thessaly test has been found to be no better than other tests such as the McMurray test and Apley's Test. When compared to McMurray, medial joint line tenderness and lateral joint line tenderness in a study from 2016, the Thessaly test was found reliable[6].

Sensitivity Specificity +LR -LR
Thessaly Test in recent studies 0.64- 0.66 0.39-0.53 1.37 0.67

In a study by Snoeker et al. from 2015, the Thessaly test had a moderate level of inter-examiner reliability with a kappa of 0.54[4]

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References[edit | edit source]

  1. 1.0 1.1 1.2 Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am. 2005;87(5):955-962.
  2. Illustration from Anatomy & Physiology, Connexions Web site., Jun 19, 2013.
  3. Goossens P, Keijsers E, Van Geenen RJ, Zijta A, Van den Broek M, Verhagen AP, Scholten-Peeters GG. Validity of the Thessaly test in evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy study. journal of orthopaedic & sports physical therapy. 2015 Jan;45(1):18-24.
  4. 4.0 4.1 Snoeker BA, Lindeboom R, Zwinderman AH, Vincken PW, Jansen JA, Lucas C. Detecting Meniscal Tears in Primary Care: Reproducibility and Accuracy of 2 Weight-Bearing Tests and 1 Non–Weight-Bearing Test. The Journal of orthopaedic and sports physical therapy. 2015 Sep 1;45(9):693-702.
  5. Blyth M, Anthony I, Francq B, Brooksbank K, Downie P, Powell A, Jones B, MacLean A, McConnachie A, Norrie J. Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley's, McMurray's and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis. Health Technology Assessment. 2015.
  6. Decary, Simon, et al. "Reliability of physical examination tests for the diagnosis of knee disorders: evidence from a systematic review." Manual therapy 26 (2016): 172-182.