To the Editor:

I have a concern about a possible error in the article “How to perform a comprehensive examination of the knee” by LT Kerri Browne PA-C, and CDR Christopher Kurtz, MD, which was published in the June 2009 issue.

The description of the McMurray's test reads: “rotate the patient's foot outward and apply force inward while passively moving the leg into full extension. A click is positive for a tear of the lateral meniscus. Shouldn't the last two words of that sentence read medial meniscus. Likewise, in the next sentence, “when rotating patient's foot inward …,” medial meniscus should be lateral meniscus.

Alexander Heckman
Kettering, Ohio

Author's response: 

Thank you for your question/concern with the McMurray's test. This can be considered a controversial issue because publications have described how to perform this test both ways.

My information came from DeLee J, Drez D, Miller M. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. 2nd ed. Philadelphia, PA: Saunders, an imprint of Elsevier; 2003.

This book states: “The most commonly described of these is the McMurray test, which is performed by first placing the knee in full flexion. Then, for the lateral meniscus, combined external rotation and valgus stress is applied to the knee as it is passively extended. For the medial side, from a flexed position, the knee is given an internal rotation and varus load as it is brought into extension. The joint line is palpated for a ‘click,' or subluxation of the meniscal fragment.”

However, after receiving your question, I looked up the original article (McMurray TP. The semilunar cartilages. Br J Surg. 1942;29:407-414). His article states: “By external rotation of the leg the internal cartilage is tested, and by internal rotation any abnormality of the posterior part of the external cartilage can be appreciated.”

In Physical Examination of the Spine and Extremities (East Norwalk, CT: Appleton-Century-Crofts; 1976), Stanley Hoppenfeld's description of the McMurray's test is similar to the the 1942 article.

Clearly, there is some confusion about the best way to interpret this test. DeLee and Drez's is the primary reference book for orthopedic sports medicine; however, the technique does come from McMurray. Obtaining a true positive result with the McMurray's test can be difficult, and depending on which publication you read, both are correct.

Lt Kerri Browne, MSBS, PA-C