Execution
- 1Position the patient prone with the knee flexed to 90 degrees.
- 2Stabilize the patient's thigh against the table.
- 3Distract the tibia and rotate it medially and laterally to stress ligaments.
- 4Then compress the tibia downward and rotate it medially and laterally to stress the meniscus.
- 5Compare pain location and whether compression or distraction is more provocative.
Positive outcome
Pain or clicking with compression and rotation suggests meniscal pathology. Pain with distraction is more suggestive of ligamentous involvement. Medial or lateral joint line symptoms help indicate the involved compartment.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Hegedus et al. (2007) | systematic review | 61 | 70 | 2.0 | 0.56 |
| Smith et al. (2015) | systematic review and meta-analysis | NA | NA | NA | NA |
CommentApley is less accurate than the textbook tradition implies and should not be used in isolation. The compression-versus-distraction logic is useful, but pain can arise from capsule, cartilage, ligament, or joint line sensitivity. Cluster with history, joint line tenderness, McMurray, Thessaly, and swelling patterns.
Moderate Clinical Value