What is the next step if the stomp test is positive for a meniscal tear?

From the Guidelines

If the stomp test is positive for a meniscal tear, the next step is to refer the patient to an orthopedic specialist for further evaluation and management. The orthopedist will likely order advanced imaging, typically an MRI of the knee, which is the gold standard for confirming meniscal tears with approximately 96% sensitivity and 97% specificity, as reported by Magee and Williams 1. While awaiting specialist consultation, the patient should follow RICE protocol (Rest, Ice, Compression, Elevation), take appropriate pain medication such as NSAIDs (e.g., ibuprofen 400-600mg three times daily with food, or naproxen 500mg twice daily), and avoid activities that exacerbate knee pain. Weight-bearing should be limited as tolerated, and crutches may be necessary if walking is painful. The orthopedic specialist will determine if the tear requires surgical intervention (arthroscopic repair or partial meniscectomy) or if conservative management is appropriate based on the tear's location, pattern, size, and the patient's activity level and goals. It's worth noting that a study by Van Dyck et al 1 showed similar high sensitivities and specificities of routine 3T and 1.5T MRI examinations in the evaluation of meniscal and ACL tears with arthroscopic correlation, suggesting that the choice of MRI protocol may not significantly impact the diagnosis of meniscal tears. Additionally, a study published in the BMJ in 2017 1 found that arthroscopic knee surgery was no better than exercise therapy for patients with a degenerative medial meniscus tear, highlighting the importance of considering conservative management options. However, the most recent and highest quality study 1 supports the use of MRI for diagnosis and specialist assessment for determining the best course of treatment. The stomp test, while helpful in clinical examination, is not definitive on its own, which is why imaging confirmation and specialist assessment are essential next steps in the diagnostic pathway. Key considerations in management include the patient's overall health, activity level, and goals, as well as the presence of any concomitant injuries or conditions, such as ACL tears or osteoarthritis, which may impact treatment decisions. In general, the goal of treatment is to alleviate symptoms, improve function, and minimize the risk of long-term complications, such as osteoarthritis. By prioritizing a thorough diagnostic evaluation and individualized treatment approach, patients with meniscal tears can achieve optimal outcomes and improve their quality of life.

From the Research

Next Steps After a Positive Stomp Test for Meniscal Tear

• If the stomp test is positive for a meniscal tear, the next step typically involves further evaluation and diagnosis to confirm the presence of a meniscal tear 2, 3.
• This may include a combination of clinical tests, such as the McMurray's test, Apley's test, and joint line tenderness test, as well as imaging studies like magnetic resonance imaging (MRI) 2, 3.
• The diagnostic value of clinical tests can be enhanced by combining at least two positive tests, which can provide sensitivity, specificity, and accuracy comparable to MRI scans 2.
• However, MRI is still necessary for the diagnostic process of meniscal injuries, particularly in cases where there is a high suspicion of a meniscal tear or when the clinical tests are inconclusive 2, 3.
• The combination of clinical tests and MRI images can provide a precise diagnosis and surgical indication for meniscus injury in patients with anterior cruciate ligament tears 2.

Diagnostic Accuracy of Clinical Tests

• The diagnostic accuracy of clinical tests, such as the Thessaly test, McMurray's test, Apley's test, and joint line tenderness test, has been evaluated in several studies 4, 5.
• These tests have been found to have varying degrees of sensitivity and specificity, with some studies suggesting that they may not be reliable enough to be used as a sole diagnostic tool 4, 5.
• However, when used in combination with other clinical tests and MRI, these tests can provide valuable information for diagnosing meniscal tears 2, 3.

Importance of MRI in Diagnosis

• MRI is a crucial diagnostic tool for confirming the presence of a meniscal tear and evaluating the extent of the injury 2, 3.
• While clinical tests can provide valuable information, MRI is necessary to confirm the diagnosis and guide treatment decisions 2, 3.
• The combination of clinical tests and MRI images can provide a comprehensive evaluation of the knee joint and help identify the presence of a meniscal tear or other knee injuries 2, 3.