Apley's Test

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Background to Appley's

The Apley grind test is used to evaluate individuals for problems of the meniscus in the knee. This test is named after Alan Graham Apley (1914 - 1996), a British orthapedic surgeon, who discovered this assessment technique. Diagnosis of meniscal injuries can be difficult as the menisci are avascular and have no nerve supply on their inner two thirds, resulting in very little pain or swelling when an injury occurs.

Test Description

Apley's grinding test involves placing the patient in the prone position with the knee flexed to 90 degrees.  The patient's thigh is then rooted to the examining table with the examiner's knee. The examiner laterally and medially rotates the tibia, combined first with distraction, while noting any excessive movement, restriction or discomfort. The process is then repeated using compression instead of distraction. If rotation plus distraction is more painful or shows increased rotation relative to the normal side, the lesion is most likely to be ligamentous. If the rotation plus compression is more painful or shows decreased rotation relative to the normal side, the lesion is most likely to be a meniscus injury.

Reliability of The Test

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Sensitivity of the Test

Diagnostic accuracy studies of meniscal tests are described to have poor methodologic quality with highly heterogeneous results, therefore poor value for clinical practice.^[1] A recent meta-analysis reports sensitivity and specificity to be 60% and 70% respectively.^[2]

Graphics/Photos

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References

David J. Magee Orthopedic physical assessment Fifth edition

Christopher Norris Sports injuries: diagnosis and management Third edition

1. Scholten RJ, Deville WL, Opstelten W, Bijl D, van der Plas CG, Bouter LM. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. J Fam Pract. 2001; 50:938-944.

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. Journal of Orthopaedic and Sports Physical Therapy, 2007; 37(9), 541-50.

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