Which test is used to diagnose meniscal pathology by combining knee flexion with tibial rotation during extension?

Which test is used to diagnose meniscal pathology by combining knee flexion with tibial rotation during extension?

• A. Thessaly
• B. Joint Line Tenderness
• C. McMurray
• D. Patellar Tilt Test

Answer: (C)

Focusing on how to load the meniscus to provoke a tear is the key. The maneuver that combines knee flexion with tibial rotation and then extension is the one that stresses the meniscal tissue as it is trapped between the femoral condyles and the tibial plateau. When performed properly, you start with the knee about 90 degrees bent, rotate the tibia to stress the suspected meniscus (external rotation for the medial meniscus, internal rotation for the lateral), and then extend the knee while maintaining that rotation. If a painful click, pop, or reproduction of joint-line pain occurs, it points to a meniscal tear because the torn edge catches or locks as the knee straightens under rotational load. Other options don’t fit this exact mechanism. The Thessaly test uses weight-bearing knee flexion with rotation at a couple of specific degrees, not the extension-loaded maneuver described here. Joint line tenderness is a palpation sign rather than a dynamic test that reproduces a tear during a specific motion. The Patellar Tilt Test assesses patellofemoral alignment and tracking, not meniscal pathology.

Focusing on how to load the meniscus to provoke a tear is the key. The maneuver that combines knee flexion with tibial rotation and then extension is the one that stresses the meniscal tissue as it is trapped between the femoral condyles and the tibial plateau. When performed properly, you start with the knee about 90 degrees bent, rotate the tibia to stress the suspected meniscus (external rotation for the medial meniscus, internal rotation for the lateral), and then extend the knee while maintaining that rotation. If a painful click, pop, or reproduction of joint-line pain occurs, it points to a meniscal tear because the torn edge catches or locks as the knee straightens under rotational load.

Other options don’t fit this exact mechanism. The Thessaly test uses weight-bearing knee flexion with rotation at a couple of specific degrees, not the extension-loaded maneuver described here. Joint line tenderness is a palpation sign rather than a dynamic test that reproduces a tear during a specific motion. The Patellar Tilt Test assesses patellofemoral alignment and tracking, not meniscal pathology.