Special Tests: Knee -Meniscus Tears, Patellofemoral Pain and Fracture
by Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS
For an introduction to Special Tests including definitions of specific terminology, what special tests measure, how we chose the tests in these lessons, and best use, check out:
Special Tests Covered in this Lesson:
- Meniscus Tear Tests
- Patellofemoral Pain Syndrome (PFPS) Test-item Cluster
- Red Flags (Fracture)
Composite Exams and "Best Practices":
The combination of patient history, physical examination, special tests and radiographs has been investigated for the diagnosis of meniscus tear; however, study results are mixed (1, 4 - 21). Generally, the accuracy of special tests and/or examination for diagnosis of meniscus tear is questionable. A diagnosis of meniscal lesion without the confirmation of arthroscopy should likely be viewed with healthy skepticism.
Although tests for patellofemoral pain syndrome (PFPS) have relatively high specificity, the diagnosis of PFPS is relatively broad (41-45). These tests may best be used to identify an assessment that replicates the concordant sign for quick re-assessment. That is, find a quick test that can be returned to over-and-over as various interventions are tested in the creation of a routine or program.
The Ottowa Knee Decision Rule has been added to this course as a potential "Red Flag Issue". It is unlikely that outpatient orthopedic professionals will use this criteria often, but it is worth having access to a quick reference in the case fracture is a legitimate concern. Note, the diagnosis of fracture is not necessary. The criteria is a set of signs that are sensitive (not necessarily specific), and imply that referral for imaging is