Execution
- 1Have the patient stand flat-footed on the tested leg while holding the examiner's hands for balance.
- 2Flex the tested knee to approximately 5 degrees for the first trial.
- 3Ask the patient to rotate the body and knee internally and externally three times.
- 4Repeat the maneuver at approximately 20 degrees knee flexion if safe.
- 5Stop if pain, locking, or giving way occurs.
Positive outcome
Joint line pain, locking, catching, or a sense of giving way during rotation is positive. The 20-degree version is usually considered more provocative for meniscus injury. The patient must be able to safely bear weight and rotate.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Karachalios et al. (2005) | NA | 90-92 | 96-97 | NA | NA |
| Smith et al. (2015) | systematic review and meta-analysis | 75 | 87 | 5.77 | 0.29 |
| Blyth et al. (2015) | specialist-care diagnostic accuracy study | 66 | 39 | 1.08 | 0.87 |
CommentThessaly was very promising in the original Karachalios study, but later HTA work and reviews found weaker accuracy. It may be difficult or unsafe in acute painful knees. Use it as one component rather than a stand-alone first-line test.
Moderate Clinical Value