Table 2

PPV and NPV of physical tests for meniscal tears with grading of quality of evidence in patients below 60 years of age

TestMedian (range)High predictive value (pv≥0.85)Moderate predictive value (0.84≥pv≥0.70)Low predictive value (pv≤0.69)
Diagnosis in patients with knee pain and clinical suspicion of meniscal tear
 Joint line tenderness
PPV 0.23 (0.22–0.23)Low
NPV 0.87 (0.85 – 0.90)Low
  MedialPPV 0.42 (0.23–0.56)Low
NPV 0.93 (0.84– 0.98)Low
  LateralPPV 0.84 (0.65–1.00)Moderate
NPV 0.93 (0.87–0.99)Moderate
  Medial + LateralPPV 0.37 (0.23– 0.47)Very low
NPV 0.86 (0.85–0.94)Very low
  MedialPPV 0.35 (0.20–0.65)Very low
NPV 0.88 (0.84–0.95)Very low
  LateralPPV 0.52 (0.20–0.69)Very low
NPV 0.90 (0.84–0.94)Very low
 Thessaly (20°)
  Medial+LateralPPV 0.57 (0.24–0.90)Very low
NPV 0.92 (0.86– 0.98)Very low
  MedialPPV 0.79 (0.21–0.87)Very low
NPV 0.92 (0.84 – 0.97)Very low
  LateralPPV 0.68 (0.20–0.84)Very low
NPV 0.95 (0.83–0.98)Very low
 Thessaly (5°)
  MedialPPV 0.23Very low
NPV 0.83Very low
  LateralPPV 0.24Very low
NPV 0.82Very low
  Medial+LateralPPV 0.41Very low
NPV 0.95Very low
  MedialPPV 0.38 (0.28–0.58)Very low
NPV 0.90 (0.87–0.95)Very low
  LateralPPV 0.47 (0.41–0.77)Very low
NPV 0.89 (0.86–0.95)Very low
 McMurray and Thessaly (20°)
  Medial+LateralPPV 0.25Very low
NPV 0.85Very low
 McMurray and joint line tenderness
  MedialPPV 0.40Very low
NPV 0.99Very low
  LateralPPV 0.75Very low
NPV 0.98Very low
 McMurray, joint line tenderness and Apley*
  MedialPPV 0.40Very low
NPV 0.97Very low
  LateralPPV 0.70Very low
NPV 0.90Very low
  • PPVs and NPVs are calculated based on data from the systematic search for the Danish national clinical guideline for meniscal pathology,12 and from an updated systematic search. The calculations are based on a prevalence of MRI-verified meniscal tears of 19% (women aged 50–59 years).7 Since PPV and NPV are dependent on the prevalence of meniscal tears, and since the prevalence of MRI-verified meniscal tears varies according to gender and age, this table is primarily relevant for younger patients.

  • *Study by Ercin et al 45 was not included as the combination of tests in that study included additional tests.

  • NPV, negative predictive value; PPV, positive predictive value.