Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 22;9(1):2325967120975511.
doi: 10.1177/2325967120975511. eCollection 2021 Jan.

A New Clinical Sign for Diagnosing Medial Meniscus Posterior Root Tear

Ramazan Akmese  1 , Batu Malatyalı  1 , Hakan Kocaoglu  1 , Zehra Akkaya  2 , Mahmut Kalem  1
Affiliations

A New Clinical Sign for Diagnosing Medial Meniscus Posterior Root Tear

Ramazan Akmese et al. Orthop J Sports Med. .

Abstract

Background: In the presence of medial meniscus posterior root tear (MMPRT), there is a possibility of reduced compression of meniscal tissue in hyperflexion as the intra-articular mobility of the meniscus increases. This phenomenon can be mimicked during clinical examination.

Purpose: To describe, evaluate, and validate the diagnostic performance of a new clinical indicator, the Akmese sign, for the diagnosis of an MMPRT.

Study design: Cohort study (diagnosis); Level of evidence, 2.

Methods: In this study, we prospectively enrolled patients aged 18 to 55 years who were scheduled for arthroscopic surgery after a diagnosis of medial meniscal lesion at a single institution between January 2016 and January 2018. All of the patients underwent preoperative examination for the Akmese sign. All surgeries were performed by a single surgeon with more than 5 years of experience in sports injury surgery, who was blinded to the Akmese sign results.

Results: A total of 273 patients with a mean age of 42.4 ± 5.3 years met the study criteria. The Akmese sign was identified as positive in 33 patients, and MMPRT was confirmed during arthroscopy in 36 cases. The performance parameters of the Akmese sign were a sensitivity of 86.1%, specificity of 99.1%, Youden index of 0.85, and kappa index of 0.88.

Conclusion: This study showed that the Akmese sign is a useful new physical examination test that can help clinicians distinguish MMPRTs from other meniscal medial meniscal pathology.

Keywords: Akmese sign; arthroscopy; knee; medial menisci; root tear; transtibial technique.

PubMed Disclaimer

Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flow diagram showing the patients included in and excluded from the study.
Figure 2.
Figure 2.
Examination for Akmese sign. The yellow line indicates the joint level, the red line indicates the medial collateral ligament. (A) The leg to be examined is brought into a figure-of-4 position, then the medial joint line is palpated for pain/sensitivity while knee flexion is lowered to 10° to 20° (near extension). (B) While taking the knee into hyperflexion (110°-130°), the medial joint line is palpated again for pain/sensitivity.
See this image and copyright information in PMC

References

    1. Ahn JH, Lee YS, Chang J-Y, Chang MJ, Eun SS, Kim SM. Arthroscopic all inside repair of the lateral meniscus root tear. Knee. 2009;16(1):77–80. - PubMed
    1. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus: similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922–1931. - PubMed
    1. Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med. 2014;42(12):3016–3030. - PubMed
    1. Bin S-I, Kim J-M, Shin S-J. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. 2004;20(4):373–378. - PubMed
    1. Choi C-J, Choi Y-J, Lee J-J, Choi C-H. Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy. 2010;26(12):1602–1606. - PubMed

LinkOut - more resources