Joint line fullness and meniscal pathology.

BACKGROUND: Meniscal tears have been associated with meniscal cysts and fullness of the knee joint line on physical examination. HYPOTHESIS: Joint line fullness is an accurate, sensitive, and specific test to detect meniscal tears. STUDY DESIGN: Prospective cohort study. METHODS: One hundred consecutive patients undergoing knee arthroscopy were included. All had physical examinations documenting the presence of joint line fullness, joint line tenderness, and the McMurray sign. Arthroscopy was the gold standard for tears. Accuracy, sensitivity, and specificity were calculated and correlated with type of tear. Sixty-one patients had a magnetic resonance imaging preoperatively (the gold standard for determining the presence of a cyst). RESULTS: Meniscal tears were found in 67 patients at arthroscopy. The accuracy, sensitivity, and specificity of joint line fullness were, respectively, 73%, 70%, and 82% in detecting meniscal tears; 68%, 87%, and 30% for joint line tenderness; and 47%, 32%, and 78% for the McMurray sign. The highest positive predictive value for detecting a tear was 88% for joint line fullness, compared with 77% for joint line tenderness and 76% for the McMurray sign. However, joint line fullness did not correlate well with the presence of a cyst, with a low positive predictive value (29%). Of those patients with joint line fullness on physical examination, 89% had a horizontal cleavage component of their tear at arthroscopy. CONCLUSION: Joint line fullness is an accurate, sensitive, and specific test to detect meniscal tears. CLINICAL RELEVANCE: The findings support the routine use of joint line fullness during physical examination along with other common tests to improve the accuracy of clinically diagnosing meniscal tears.

Effect of the oral contraceptive pill on ligamentous laxity.

OBJECTIVE: Women are 4 to 8 times more likely to sustain a serious knee injury than their male counterparts. Previous studies have found that female sex steroids affect ligamentous tissue properties. The hypothesis is that there exists a difference in ligamentous laxity between oral contraceptive pill (OCP) users and nonusers. DESIGN: Blinded, single-factor, posttest-only control group design. SETTING: McGill University Sport Medicine Clinic, Montreal, Que-bec, Canada. PARTICIPANTS: One hundred twenty-seven female McGill University varsity athletes. INTERVENTIONS: Participants filled out a screening questionnaire and underwent KT-1000 measurements by 1 blinded examiner. Exclusion criteria related to underlying knee pathology, and hormonal factors were identified with the questionnaire. MAIN OUTCOME MEASUREMENTS: Independent sample, 2-tailed t tests were performed on the nondominant knee data of the OCP users and nonusers. RESULTS: Mean anterior translations at 67 N were 3.00 +/- 1.04 mm for the OCP users and 3.86 +/- 1.72 mm for the nonusers (P = 0.011); at 89 N, 3.98 +/- 1.13 mm vs. 4.83 +/- 1.82 mm, respectively (P = 0.018). Mean anterior translations at 67 N were 2.95 +/- 0.93 mm for the non-menstruating OCP users and 3.86 +/- 1.72 mm for the nonusers (P = 0.008); at 89 N, 3.88 +/- 1.06 mm vs. 4.83 +/- 1.82 mm, respectively (P = 0.011). CONCLUSIONS: Oral contraceptive pill use yielded statistically significant decreases in anterior translation of the tibia as compared with nonusers. The OCP may have a role to play in the prevention of ACL injuries by prophylactically targeting 1 of the variables responsible for the increased ACL injury rates in women.