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Special Test

Apley Grinding Test

Apley grinding Test (or Apley’s compression test) is used to evaluate the medial or lateral Meniscal Injury of the knee joint.

How do you perform the Apley’s Grinding test?

  • Place the patient in prone position,
  • The patient is then asked to flex the affected knee to 90 degrees,
  • The Examiner’s one hand grasps patient’s heel and ankle while the other hand stabilizes the leg.
  • The Examiner compresses the flexed knee joint and the menisci by pushing the patient’s foot and tibia down into the table, followed by internal and external rotation of the tibia.

What does a positive Apley’s compression test?

Apley’s compression test is positive if pain is elected on either side of the knee joint:

See Also: Knee Meniscus Tear
  • If the pain is elected on the medial aspect, this suggests a medial meniscus injury.
  • If the Pain is elected on the lateral aspect, this suggests a lateral meniscus injury.

Sensitivity & Specificity

A meta-analysis by B Ockert 1 to evaluate the value of the clinical examination in suspected meniscal injuries of the knee found that the Apley Grinding test has the following accuracy:

  • Sensitivity: 38 %
  • Specificity: 84 %

Another Systematic review and meta-analysis by Eric J Hegedus 2 to evaluate the accuracy of three physical examination tests (McMurray test, Apley test, and joint line tenderness), the Apley test has a sensitivity of 63 % and a specificity of 77%.

Modified Apley Test:

Wirth describes a modication of the grinding test (compression test), in which the knee is extended with the lower leg in flxed rotation.

Wirth was able to confirm the presence of a meniscus lesion in over 85% of all cases with this modified Apley test.

Reference

  1. Ockert B, Haasters F, Polzer H, Grote S, Kessler MA, Mutschler W, Kanz KG. Der verletzte Meniskus: Wie sicher ist die klinische Untersuchung? Eine Metaanalyse [Value of the clinical examination in suspected meniscal injuries. A meta-analysis]. Unfallchirurg. 2010 Apr;113(4):293-9. German. doi: 10.1007/s00113-009-1702-2. PMID: 19960176.
  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. doi: 10.2519/jospt.2007.2560. PMID: 17939613.
  3. Clinical Tests for the Musculoskeletal System 3rd Edition.
  4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
  5. Sarvdeep S. Dhatt, Sharad Prabhakar – Handbook of Clinical Examination in Orthopedics.
  6. Campbel’s Operative Orthopaedics 12th edition Book.
  7. Millers Review of Orthopaedics -7th Edition Book.
  8. Ronald McRae – Clinical Orthopaedic Examination 6th Edition Book
  9. Netter’s Orthopaedic Clinical Examination An Evidence-Based Approach 3rd Edition Book
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