Evaluation of meniscal click for detecting meniscal tears in stifles with cranial cruciate ligament disease.

OBJECTIVE

To assess the diagnostic efficacy of palpable meniscal click by evaluating the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of preoperative palpable meniscal click compared with examination during surgery.

STUDY

DESIGN

Prospective case series.

SAMPLE POPULATION: Dogs (n = 56) with cranial cruciate ligament (CCL) injury.

METHODS

Stifles were examined before anesthesia (EBA) and during anesthesia (EDA) before surgery for palpable meniscal click. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated for EBA and EDA using examination during surgery as the gold standard.

RESULTS

EBA was 45.8% sensitive and 94.4% specific for meniscal tear. EDA was 58.3% sensitive and 94.4% specific for meniscal tear. Positive predictive value for palpable meniscal click during EBA was 84.6%, negative predictive value was 72.3%, and diagnostic accuracy was 75.0%. Positive predictive value for palpable meniscal click during EDA was 87.5%, negative predictive value was 77.3%, and diagnostic accuracy was 80.0%. EBA and EDA were significantly associated with the presence of intra-operative meniscal injury (P = .0002 and P < .0001, respectively). Meniscal tears were seen more often in stifles with a full CCL tear as compared to partial CCL tears at a ratio of 11:1.

CONCLUSIONS

Presence of a palpable meniscal click during physical examination is strongly indicative of a meniscal tear diagnosed at surgery. The meniscus should always be carefully examined at surgery despite preoperative findings, because the absence of a palpable meniscal click is not a strong indicator for a normal meniscus.