What Is Apley’s Test?
The Apley grind or compression test is a physical examination maneuver first described by the British orthopedic surgeon Alan Graham Apley. It is commonly performed to evaluate potential meniscal injury of the knee, often in conjunction with the Apley distraction test. Meniscal injuries are prevalent and correlate with significant pain and morbidity. Meniscal injuries are uncommon in patients younger than ten years old.
Men are more likely to be affected than women, and it is assumed that this is because men participate in more rotational-injury-prone activities, including contact sports. Prompt diagnosis of these injuries by appropriate physical assessment, provocative tests such as the Apley grind test and Apley distraction test, and sophisticated imaging, including magnetic resonance imaging (MRI), are essential for providing appropriate therapy and a positive outcome for the patient.
What Are the Indications of Apley’s Test?
When a patient comes in with knee discomfort, the doctor should suspect meniscus damage, especially if the patient had a twisting accident. The injury could happen with or without the external force in the knee. Pain is usually felt at the joint line of the knee. A common symptom is pain, along with mechanical complaints like locking, clicking, catching, or difficulty being able to stretch the knee fully. Ligamentous injuries usually coexist with these ailments. Applied external force to the lateral knee may cause several problems. This category of injuries includes harm to the lateral or medial meniscus together with concurrent injuries to the medial collateral ligament (MCL) and anterior cruciate ligament (ACL). Joint line discomfort, joint effusion, and reduced range of motion are typical findings during a physical examination.
What Are the Contraindications of Apley’s Test?
Patients with severe knee abnormalities should not undergo the Apley grind test. In cases of severe trauma with knee deformity and apparent fracture or dislocation, it is advisable to postpone any provocative testing, such as the Apley grind and distraction tests, until imaging results are obtained. Furthermore, patients who have had amputations in the past should receive extra attention and technique modifications.
What Is the Technique Involved in Apley’s Test?
The patient should lie in the prone position with one leg completely extended and resting on the examination table and the other knee flexed to a 90-degree angle for testing. By pressing down on the sole and stabilizing the posterior thigh with the other hand, the examiner can provide a downward axial loading pressure to compress the knee. Compression should be used in conjunction with both internal and external rotation. If there is discomfort or limitation during compression and either external or internal rotation, the Apley compression test is regarded as successful. A medial meniscus damage is indicated if the patient feels pain around the medial side of the knee. Conversely, pain over the lateral side of the knee implies a lateral meniscus injury in the patient.
The Apley distraction test, which evaluates ligamentous damage rather than meniscal injury, is frequently used in conjunction with the Apley compression test. The examiner must pull up on the injured leg rather than provide a downward loading force to conduct the distraction test while the patient remains in the same prone posture. This stress strains the knee ligaments. A successful outcome is when the patient feels pain. Pain accompanied by knee distraction substantially reduces the risk of meniscal disease. The stress exerted on the meniscus is significantly lessened due to the type of distraction force.
What Are the Complications of Apley’s Test?
The Apley compression test has not been associated with any problems. Even though individuals can feel localized knee discomfort, this needs to be elicited because it means the test is positive. As mentioned in the contraindications section, a patient with a significant knee deformity following catastrophic trauma should not undergo this test. Severe consequences, including exacerbating pre-existing fractures or turning a closed fracture into an open fracture, can occur.
What Is the Clinical Significance of Apley’s Test?
Conservative care is the primary method of management of degenerative meniscal tears. Treatment for meniscal injuries involves non-operative methods like medication and physical therapy. Peripheral tears may require surgical repair of a torn meniscus due to the abundant blood supply. On the other hand, tears that are radial, horizontal, or degenerative are less suitable for surgical repair. Meniscal injury final care depends greatly on the specifics of each case.
Hashemi et al. examined 86 individuals using the Apley compression test, McMurray test, and Thessaly test and then verified their results with MRI knee and arthroscopy. The Thessaly test performed better than other clinical tests in assessing the meniscal injury.. The findings of the Thessaly test showed superiority in terms of both positive and adverse predictive values (85.3 and 94.2) of accuracy (90.69 %), specificity (90.7 %), and sensitivity (90.6 %). The McMurray and Apley tests were compared in this study, and the results showed no statistically significant variation.
Shekarchi et al. performed a prospective observational research with 106 participants. Thessaly test results for medial meniscus tears were more sensitive (56.2 %). In comparison, McMurray test results and medial joint-line pain findings were considerably more specific (89.1 % and 88.0 %, respectively) when compared to MRI (magnetic resonance imaging) results. The remaining tests were equally specific; however, the McMurray test remained the most sensitive (56.2 %) regarding lateral meniscus injuries.
Hegedus's meta-analysis revealed that using multiple tests instead of just one is the best way to diagnose a meniscal tear. In the presence of chondromalacia or anterior cruciate ligament pathology, these clinical tests will be less useful in diagnosing meniscal disease.
Conclusion:
The Apley compression test can be performed by several interprofessional healthcare team members, including emergency and sports medicine doctors, orthopedic nurses and surgeons, chiropractors, and physical therapists. It is imperative to recognize that the test has limitations and that an MRI should be used to confirm the medical diagnosis. An orthopedic surgeon should be consulted for final management of patients with meniscal injuries. The treatment of knee injuries will be guided by the coordination of interprofessional activities and open discussion of exam findings and other case information, leading to the best possible outcomes.
