The McMurray test is used to assess the presence of meniscal tears within the knee.

Background

Clinical tests used for the detection of meniscal tears provide varying levels of diagnostic parameters including sensitivity and specificity. MRI is considered the most accurate diagnostic tool for detecting meniscal injuries while arthroscopy is widely considered the gold standard ¹. Of the physical examinations available to test for meniscal pathology, the McMurray test is thought to be the most widely used clinically ². One study found that combining the Thessaly test with the McMurray test improves diagnostic accuracy ³ while another study concluded that combining these tests does not provide overall improved diagnostic accuracy ⁴.

Procedure

The patient lies supine while the examiner provides varus and valgus stress in addition to internal and external rotation to the patient's knee during passive extension. ^4,5:

• the examiner holds the knee and palpates the joint line with one hand, thumb on one side and fingers on the other

• the other hand holds the sole of the patients foot and acts to support the limb and provide the required movement through range

• from maximal flexion, the knee is passively extended with internal rotation of the tibia and varus stress

• the knee is returned to maximal flexion and then passively extended again, this time with external rotation of the tibia and valgus stress

Internal rotation + varus stress = lateral meniscus

External rotation + valgus stress = medial meniscus

The test is positive if there is reproduction of pain, locking or clicking which may indicate a compromised meniscus. 

Evidence

Studies looking at diagnostic accuracy, sensitivity and specificity have demonstrated varied values. A 2015 systematic review reported a diagnostic accuracy between 56-84% ⁵. A prospective cohort study of 213 patients found poor sensitivity for medial and lateral meniscus tears of 48% and 65% respectively ⁶. Conversely specificity for medial and lateral meniscal tears was high, 94% and 86% respectively ⁶. The positive likelihood ratio for medial and lateral meniscal tears was 8 and 5 respectively ⁶.

History and etymology

The test was first described in 1940 by orthopedic surgeon Thomas Porter McMurray (1888-1949) ^7,9. The original test has been slightly altered with the addition of varus and valgus stress ⁸.