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McMurray Test: Knee Examination for Meniscal Tears

The McMurray Test is a clinical examination used to diagnose meniscal tears in the knee joint. It is widely applied in orthopedic and sports medicine assessments.

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The McMurray Test is a clinical examination used to diagnose meniscal tears in the knee joint. It is widely applied in orthopedic and sports medicine assessments.

What is the McMurray Test?

The McMurray Test is a clinical orthopedic examination used to detect meniscal tears in the knee joint. It was named after the British surgeon Thomas Porter McMurray, who first described it in the early 20th century. The test is one of the most commonly performed physical examination maneuvers for knee complaints and serves as an initial diagnostic indicator of possible meniscal injury.

Anatomical Background

The knee joint contains two crescent-shaped cartilage discs known as menisci: the medial (inner) and lateral (outer) meniscus. These structures act as shock absorbers between the femur (thigh bone) and the tibia (shin bone), distribute body weight evenly, and help stabilize the joint. Meniscal damage often results from twisting motions, sports injuries, or age-related degeneration.

How the Test is Performed

The McMurray Test is typically performed as follows:

The patient lies in a supine position (on their back) on the examination table.
The examiner fully flexes the knee joint (maximum flexion).
To test the medial meniscus, the lower leg is externally rotated while the knee is slowly extended. A valgus stress (inward pressure) is applied to the knee simultaneously.
To test the lateral meniscus, the lower leg is internally rotated while the knee is extended, with varus stress (outward pressure) applied.
A positive test result is indicated by an audible or palpable click, snap, or pop within the knee joint, accompanied by pain along the joint line.

Diagnosis and Clinical Significance

A positive McMurray Test provides a clinical indication of a meniscal tear but is not used as a standalone diagnostic tool. Studies report a sensitivity of approximately 50–70 % and a specificity of 70–90 %, meaning a negative result does not entirely rule out meniscal injury. Further diagnostic workup is recommended to confirm findings:

MRI (Magnetic Resonance Imaging): The gold standard for visualizing meniscal lesions
Arthroscopy: An endoscopic procedure that allows direct visualization and simultaneous treatment of meniscal damage
Additional clinical tests such as the Apley Test or Thessaly Test

Combination with Other Clinical Tests

The McMurray Test is commonly combined with other examination techniques to improve diagnostic accuracy. These include:

Apley Compression Test: Meniscal assessment in the prone position through compression and rotation
Steinmann Sign: Pain provocation through rotation of the flexed knee
Thessaly Test: Functional weight-bearing assessment of the meniscus in single-leg stance

Treatment of Meniscal Tears

When a meniscal tear is confirmed, treatment depends on the extent and type of injury, as well as the age and activity level of the patient:

Conservative treatment: Physiotherapy, pain management, rest, and muscle strengthening exercises
Surgical treatment: Arthroscopic meniscal repair (for tears in well-vascularized areas) or partial meniscectomy (removal of the damaged portion)

The goal of treatment is to restore full joint function and prevent long-term complications such as premature knee osteoarthritis.

References

Hegedus E.J. et al. - Physical examination tests predicting the presence of meniscal pathology. In: British Journal of Sports Medicine, 2007.
Karachalios T. et al. - Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. In: Journal of Bone and Joint Surgery, 2005.
Solomon D.H. et al. - The rational clinical examination: Does this patient have a torn meniscus? In: JAMA, 2001.

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