What is the McMurray Test?
The McMurray test is a physical examination maneuver used to diagnose meniscal tears of the knee, performed by rotating the tibia (internally or externally) while simultaneously extending the knee from a flexed position, with a positive test indicated by a palpable click or pop along the joint line accompanied by pain. 1
How the Test is Performed
The McMurray test involves the following technique:
- Patient positioning: The patient lies supine with the knee fully flexed
- Examiner hand placement: One hand palpates the joint line while the other grasps the heel/foot
- Maneuver execution:
- To test the lateral meniscus: internally rotate the tibia while extending the knee
- To test the medial meniscus: externally rotate the tibia while extending the knee
- Positive finding: A palpable click, pop, or clunk along the joint line accompanied by pain indicates a tear
Diagnostic Performance
According to the 2025 AAOS guidelines, physical examination including the McMurray test can effectively diagnose acute meniscal tears with moderate evidence strength 1. The test characteristics are:
- Sensitivity: 26-62% (relatively low - many tears will be missed) 2, 3
- Specificity: 84-94% (high - when positive, it's usually accurate) 4, 3
- Accuracy: 61.2% for medial meniscus, 91.5% for lateral meniscus 5
Critical Clinical Interpretation
The McMurray test should never be used in isolation. The 2025 AAOS guidelines emphasize that combining physical examination findings (joint line tenderness + McMurray test + Thessaly test) yields significantly greater accuracy than any single finding 1.
Important Caveats:
- Low sensitivity means negative test does NOT rule out meniscal tear - approximately 40-74% of actual tears will have a negative McMurray test 2, 5
- High specificity means positive test is reliable - when the test is positive, there's an 84-94% chance a tear exists 4, 3
- Concomitant pathology affects interpretation: The test may reflect meniscal pathology combined with cartilage injury rather than isolated meniscal tears 6
- Perimeniscal synovitis influences results: In degenerative meniscus tears with osteoarthritis, a positive McMurray test may be driven more by inflammatory synovitis than the tear itself 7
- Medial joint line tenderness loses accuracy when medial compartment cartilage injury is present 8
Practical Algorithm for Use
When evaluating suspected meniscal tears:
- Perform McMurray test as part of comprehensive knee examination (not alone)
- Combine with joint line tenderness and Thessaly test for optimal accuracy 1
- If McMurray test is positive: High likelihood of meniscal tear - proceed with MRI if surgical intervention being considered
- If McMurray test is negative: Cannot exclude meniscal tear - rely on combined clinical findings and consider MRI if clinical suspicion remains high
- In patients >40 years with osteoarthritis: Interpret positive McMurray with caution as it may reflect synovitis rather than mechanically significant tear 7
MRI remains the preferred imaging modality when diagnosis confirmation is needed, with the highest accuracy for detecting meniscal tears based on strong evidence 1.