Thessaly Test

Thessaly-testen er en dynamisk klinisk test som benyttes for å identifisere meniskskader. Testen reproduserer belastning på kneet for å fremprovosere symptomer på medial eller lateral meniskskade. Et positivt funn innebærer leddsmerte langs leddlinjen eller følelse av låsing/fanging i kneet [1].

Execution Technique

Patient position:The patient stands on one leg while holding the examiner’s outstretched hands for support.

Test procedure:

• The patient flexes the knee to 5° and rotates the body medially and laterally three times.

• The test is repeated at 20° knee flexion.

• The test begins on the uninjured side to familiarize the patient with the procedure.

• Positive test: The patient experiences joint line pain or a sensation of locking/catching.

Evidence and Diagnostic Value

Karachalios et al. (2005) reported high sensitivity and specificity at 20° flexion:

Thessaly Test at 5° Flexion

Injury Type	Sensitivity	Specificity	+LR	-LR
Medial meniscus	66%	96%	16.5	0.35
Lateral meniscus	81%	91%	9.0	0.21
Combined ACL + meniscus	65%	83%	–	–

Thessaly Test at 20° Flexion

Injury Type	Sensitivity	Specificity	+LR	-LR
Medial meniscus	89%	97%	29.67	0.11
Lateral meniscus	92%	96%	23.0	0.21
Combined ACL + meniscus	80%	91%	–	–

Later studies (2015–2016) have shown that the Thessaly Test may not outperform McMurray’s or Apley’s tests【3】【4】【5】.

• Snoeker et al. (2015): Moderate inter-rater reliability (Kappa = 0.54)【4】.

Thessaly Test in Newer Studies (2015–2016)

Metric	Sensitivity	Specificity	+LR	-LR
Range values	0.64–0.66	0.39–0.53	1.37	0.67

Clinical Significance

• The Thessaly Test is a quick and simple tool to evaluate meniscal pathology.

• It demonstrates higher diagnostic value at 20° flexion.

• For a more reliable diagnosis, the test should be combined with McMurray’s and Apley’s tests.

Sources:

1. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am. 2005;87(5):955-962.

2.  Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.

3. Goossens P, Keijsers E, Van Geenen RJ, Zijta A, Van den Broek M, Verhagen AP, Scholten-Peeters GG. Validity of the Thessaly test in evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy study. journal of orthopaedic & sports physical therapy. 2015 Jan;45(1):18-24.

4. Snoeker BA, Lindeboom R, Zwinderman AH, Vincken PW, Jansen JA, Lucas C. Detecting Meniscal Tears in Primary Care: Reproducibility and Accuracy of 2 Weight-Bearing Tests and 1 Non–Weight-Bearing Test. The Journal of orthopaedic and sports physical therapy. 2015 Sep 1;45(9):693-702.

5. Blyth M, Anthony I, Francq B, Brooksbank K, Downie P, Powell A, Jones B, MacLean A, McConnachie A, Norrie J. Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley's, McMurray's and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis. Health Technology Assessment. 2015.

6. Décary S, Ouellet P, Vendittoli PA, Desmeules F. Reliability of physical examination tests for the diagnosis of knee disorders: Evidence from a systematic review. Man Ther. 2016 Dec;26:172-182. doi: 10.1016/j.math.2016.09.007.