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Apley Grinding Test: Knee Diagnosis Explained

The Apley Grinding Test is a clinical examination test used to diagnose meniscus injuries in the knee joint. It is a standard tool in orthopedic diagnostics.

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Things worth knowing about "Apley Grinding Test"

The Apley Grinding Test is a clinical examination test used to diagnose meniscus injuries in the knee joint. It is a standard tool in orthopedic diagnostics.

What is the Apley Grinding Test?

The Apley Grinding Test is a clinical examination procedure used in orthopedics and sports medicine to diagnose meniscal lesions -- injuries to the cartilage discs located within the knee joint. The test is named after British orthopedic surgeon Alan Graham Apley, who developed it in the mid-20th century. It is considered a standard component of clinical knee assessment and helps differentiate between meniscal injuries and ligamentous injuries of the knee.

How the Test is Performed

The Apley Grinding Test is carried out in a specific, standardized body position:

The patient lies in a prone position (face down) on the examination table.
The affected knee is flexed to 90 degrees.
The examiner kneels on the back of the patient's thigh to stabilize the femur (thigh bone).
The lower leg is then compressed downward while simultaneously being internally and externally rotated.
This compressive rotation is referred to as the grinding component, as it presses and rotates the joint surfaces against one another.

In a second step, the lower leg is distracted upward (pulled away from the joint) while rotation is again applied. This distraction phase is used to assess the ligamentous structures of the knee, particularly the collateral ligaments.

Interpretation of Results

The findings of the Apley Grinding Test are interpreted based on the location of pain reported by the patient:

Pain during compression and rotation: Suggests a meniscal lesion. Medial (inner side) or lateral (outer side) pain indicates which meniscus may be affected.
Pain during distraction: More likely indicates a ligamentous injury, such as damage to the collateral ligaments.
No pain: Considered a negative result, making a meniscal tear less likely.

Clinical Significance

The Apley Grinding Test is a valuable component of the clinical knee examination. However, it is typically used in combination with other orthopedic tests, as its diagnostic accuracy when used in isolation is limited. Complementary tests include:

McMurray Test
Thessaly Test
Steinmann Sign

Research indicates that the sensitivity (ability to correctly identify a condition) and specificity (ability to correctly rule out a condition) of the Apley Test are variable across studies. A positive result should therefore always be confirmed through imaging, particularly Magnetic Resonance Imaging (MRI), before a final diagnosis is made.

When is the Test Used?

The Apley Grinding Test is typically applied in the following clinical situations:

Suspected meniscal tear following a sports injury or trauma
Chronic knee pain with an unclear cause
Preoperative assessment before knee surgery
Follow-up examination after knee procedures

Safety and Contraindications

The test is generally safe and non-invasive. However, it should be performed with caution or avoided entirely in cases of:

Acute fractures around the knee or lower leg
Severe ligamentous ruptures with joint instability
Significant pain that prevents the patient from lying in a prone position

References

Apley, A. G. (1947). A system of orthopaedics and fractures. Butterworth & Co. London.
Scholten, R. J. et al. (2001). The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. Journal of Family Practice, 50(11), 938-944. PubMed PMID: 11711009.
Hegedus, E. J. et al. (2007). Physical examination tests of the knee: a systematic review with meta-analysis. British Journal of Sports Medicine, 41(7), 399-408. doi:10.1136/bjsm.2006.033878.

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