Apleys grind test

Apley’s Grind Test is a classical orthopedic examination maneuver designed to assess the condition of the meniscus in the knee and identify possible meniscal tears. The test was first described by British orthopedic surgeon Alan Graham Apley [1].

A positive test may indicate:

• Meniscal injury (if compression elicits pain).

• Ligament injury (if distraction elicits more pain).

The test is often performed together with Apley’s Distraction Test for differential assessment.

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Anatomy – The Meniscus

The meniscus is a C-shaped fibrocartilaginous structure that acts as a shock absorber between the femur and tibia [4].

There are two menisci in each knee:

• Medial meniscus – Larger, less mobile, firmly attached to the medial collateral ligament (MCL).

• Lateral meniscus – Smaller, more mobile, less firmly attached.

Blood supply

• Outer one-third (red zone): Good vascularization → higher healing potential.

• Inner two-thirds (white zone): Avascular, nourished mainly by diffusion → poor healing capacity [3].

Common meniscal tear types

• Flap tear

• Radial tear

• Horizontal tear

• Bucket-handle tear

• Degenerative tears

Indications

Suspicion of meniscal injury arises after:

• Rotational knee trauma with the foot planted [6].

• Direct external force to the knee (e.g., contact sports).

• Complex injuries such as the “unhappy triad” (ACL + MCL + meniscus rupture).

Typical symptoms

• Joint line pain.

• Clicking, locking, or catching in the knee.

• Swelling and reduced mobility.

Test Execution

Patient position

• The patient lies prone (face down).

• The knee is flexed to 90°.

Examiner position

• Stabilize the patient’s thigh against the table using your own knee.

• Hold the patient’s ankle firmly with both hands.

Test procedure

1. Distraction test (ligament assessment):

• Apply upward traction on the tibia and rotate medially and laterally.

• Positive finding → Pain suggests possible ligament injury.

2. Compression test (meniscus assessment):

• Apply downward pressure through the tibia into the table while rotating medially and laterally.

• Positive finding → Pain suggests possible meniscal pathology.

Interpretation

• Positive distraction test → Suspected ligament injury.

• Positive compression test → Suspected meniscal injury.

• Restricted rotation → Possible meniscal pathology.

Reliability and Diagnostic Accuracy

• Sensitivity: ~60%

• Specificity: ~70% [10]

Apley’s test has limited diagnostic value when used in isolation. Its reliability improves when combined with:

• McMurray’s Test

• Thessaly’s Test

• Joint line palpation

• MRI (gold standard)

Clinical Relevance

Apley’s Grind Test remains a practical component of clinical knee assessment. However, it should not be used alone to establish diagnosis. A comprehensive approach should include:

• Detailed patient history

• Physical examination (Apley’s, McMurray’s, Thessaly’s)

• Imaging (MRI for confirmation)

Treatment Considerations

• Conservative management: NSAIDs, physiotherapy, activity modification.

• Surgical management: Arthroscopic meniscal repair or partial meniscectomy in acute peripheral tears with good vascular supply.

Conclusion

Apley’s Grind Test is a simple and informative clinical maneuver for evaluating knee pathology. It helps differentiate between meniscal and ligamentous injury but has moderate diagnostic accuracy. It is best applied in combination with other clinical tests and imaging to reach a reliable diagnosis.

Sources:

1. Who Named It. Alan Graham Apley, Available from: http://www.whonamedit.com/doctor.cfm/203.html [last accessed 28/5/9]

2. Medial meniscus. (2018, March 14). Physiopedia, . Retrieved 11:38, May 28, 2018 from https://www.physio-pedia.com/index.php?title=Medial_meniscus&oldid=184430.

3. David J. Magee. Orthopedic Physical Assessment. 5th Edition. W.B. Saunders, London; 2002.

4. Lateral meniscus. (2018, March 14). Physiopedia, . Retrieved 11:39, May 28, 2018 from https://www.physio-pedia.com/index.php?title=Lateral_meniscus&oldid=184431.

5. Medial meniscus. (2018, March 14). Physiopedia, . Retrieved 11:38, May 28, 2018 from https://www.physio-pedia.com/index.php?title=Medial_meniscus&oldid=184430.

6. Meniscus rupture. (2018, January 25). Physiopedia, . Retrieved 11:43, May 28, 2018 from https://www.physio-pedia.com/index.php?title=Meniscus_rupture&oldid=182515.

7.  Christopher Norris. Sports Injuries: Diagnosis and Management, Third Edition. Butterworth-Heinemann;2004.

8. Patrick J. McMahon (2006). Current diagnosis & treatment in sports medicine. McGraw-Hill Medical.

9. Scholten RJ, Deville WL, Opstelten W, Bijl D, van der Plas CG, Bouter LM. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. J Fam Pract. 2001; 50:938-944.

10. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. Journal of Orthopaedic and Sports Physical Therapy, 2007; 37(9), 541-50.

11.  http://services.epnet.com/getimage.aspx?imageiid=7305

12. Athletic Advisor. Meniscal MRI. Available from: www.athleticadvisor.com/Injuries/LE/Knee/mensical_mri.htm 

13. www.eorthopod.com/images/ContentImages/knee/knee_meniscus_surgery/knee_meniscus_surgery_rationale02.jpg