***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The aim of this prospect i ve study was to compare the accuracy of clinical examination and magnetic resonance imaging ( MRI ) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making . Methods A total of 30 patients with a preoperative MRI underwent arthroscopy over a 5-month period . All patients had a clinical examination performed by an experienced knee surgeon , a specialist in general orthopedics , a senior resident , and a fourth-year resident . These examiners recorded and evaluated the results of seven tests : the medial and lateral joint line tenderness test , the McMurray test , the Apley test , the Stienmann I test , the Payr ’s test , Childress ’ sign , and the Ege ’s test . The injury was classified as a meniscal tear if there were two positive tests . Clinical history , physical examination , and MRI findings were compared with the arthroscopic findings . The accuracy , sensitivity , specificity , positive predictive value ( PPV ) , and negative predictive value ( NPV ) of these methods of evaluation were then calculated . Results Clinical examination performed by an experienced knee surgeon had better specificity ( 90 % vs. 60 % ) , positive predictive value ( 95 % vs. 83 % ) , negative predictive value ( 90 % vs. 86 % ) , and diagnostic accuracy ( 93 % vs. 83 % ) than MRI for medial meniscal tears . These parameters showed only a marginal difference in lateral meniscal tears . The experienced knee surgeon had better sensitivity , specificity , predictive values , and diagnostic accuracy parameters for medial meniscus tears in comparison with the other three examiners . Conclusion These results indicate that clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear . Level of evidence II Summary The accuracy of diagnosis was tested in a prospect i ve study of 145 patients who were arthroscoped because a meniscal tear was suspected clinical ly . Multiple variate analysis was used to evaluate 68 different clinical parameters . The clinical accuracy was 61 % as a tear was demonstrated in 88 knees ; 73 of these tears were associated with other intraarticular abnormalities . Thirteen knees were entirely normal at arthroscopy . It was possible to predict a meniscal tear in 8 out of 10 patients .RésuméUne enquête prospect i ve portant sur 145 malades chez qui a été pratiquée une arthroscopie en raison d'une suspicion clinique de lésion méniscale a permis d'étudier la justesse du diagnostic . On a eu recours à une analyse statistique multivariée pour évaluer 68 paramètres cliniques différents . L'exactitude clinique était de 61 % puisqu'une déchirure du ménisque a été découverte dans 88 genoux ; 78 d'entre elles s'accompagnaient d'une autre lésion intra-articulaire . Treize genoux étaient strictement normaux à l'arthroscopie . Il apparaît donc que la prédiction d'une lésion méniscale est possible dans 8 cas sur 10 A prospect i ve study involving 190 patients presenting with symptoms suggesting internal derangements of the knee was performed to demonstrate the likelihood of symptoms and signs produced by medial patellar plica to mimic those of medial meniscal lesions . Arthroscopic examination was done in each patient by an independent examiner after the establishment of clinical diagnoses . Only patients with isolated medial patellar plica ( Group A , n = 54 ) and isolated medial meniscal lesion ( Group B , n = 19 ) were further assessed . Although isolated medial patellar plica can produce symptoms and signs similar to medial meniscal lesion , statistical analysis clearly demonstrated that giving way , locking , medial joint line tenderness and positive McMurray test were more commonly detected in Group B ( p < 0.05 ) . The sensitivity of detecting either one or more than one symptom or sign included in this study was higher in group B ( 89.5 % ) , but a positive symptom or sign was more predictive in Group A ( 39.2 % ) . Considering the variation of prevalence of medial patellar plica in other regions , the results from this study indicate that giving way , locking , clicking , medial joint line tenderness and positive McMurray test would be more predictive of medial patellar plica and thus clinical diagnosis of medial meniscal lesion might be affected if the prevalence of isolated medial patellar plica exceeded 16.6 per cent & NA ; Hypertonic saline effectively excites muscle nociceptors . Muscle hyperalgesia was assessed in osteoarthritis ( OA ) by intramuscular infusion of 0.5 ml hypertonic saline ( 6 % ) into the tibialis anterior muscle in humans . Patients ( n=14 ) with OA in the lower extremities were compared with an equal number of age‐ and sex‐matched healthy controls . Ten of the 14 OA patients had pain in the knee joint as the most common presenting complaint . Visual analogue scale ( VAS ) pain intensity and assessment of pain areas were recorded before infusion and immediately , 2 , 5 , 10 and 20 min after infusion , and then every 10 min , until the pain vanished . The mean pain offset time in OA patients ( 11.3±7.9 min ) was larger as compared with the control subjects ( 6.04±2.1 min ) ( P=0.025 ) . OA patients had increased pain intensity VAS after the infusion in the right leg compared with controls ( P<0.05 ) . Referred and radiating pain areas at 2 min post‐infusion increased in OA patients and not in controls as compared with the local pain areas ( P<0.05 ) . It is concluded that muscle hyperalgesia and extended pain areas might be due to central sensitization caused by painful osteoarthritis A prospect i ve and retrospective study was undertaken to compare the accuracy of magnetic resonance imaging ( MRI ) with clinical examination in diagnosing meniscal and anterior cruciate ligament ( ACL ) tears . Pathological findings were then confirmed during arthroscopy . One hundred fifty-four patients clinical ly diagnosed with a meniscal or ACL tear who ultimately had arthroscopic knee surgery were evaluated ; 100 patients underwent clinical examination followed by MRI , and 54 underwent clinical examination alone .  The presence or absence of meniscal and ACL tears was confirmed during arthroscopy . The accuracies of clinical examination and MRI  were compared for the 100 patients who underwent both clinical examination and MRI .  The accuracy of MRI  was 75 % for medial meniscal tears , 69 % for lateral meniscal tears and 98 % for ACL tears . The accuracy of clinical examination was 82 % for medial meniscal tears , 76 % for lateral meniscal tears and 99 % for complete tears of the ACL . Furthermore , the accuracy of clinical examination for the 54 patients who underwent clinical examination alone was not significantly different from the accuracy of clinical examination in the 100 patients who also underwent MRI . There was no significant difference between the accuracy of clinical examination and MRI in the diagnosis of meniscal and ACL tears and , overall , MRI  contributed to treatment in only 16 of 100 cases . Based on these findings , we feel that MRI , except in certain circumstances , is an expensive and unnecessary diagnostic test in patients with suspected meniscal and ACL pathology Rapidly progressing medical technology sometimes obscures the importance of history and physical examination . This study was design ed to assess the value of MRI and clinical examination in the diagnosis of ligamentous and meniscal knee injuries in comparison with arthroscopic findings . In the year 2003 - 2004 , we conducted a prospect i ve , single blind study to assess ligamentous and meniscal injuries of the knee in patients with acute knee trauma . The mean age was 27.9 years . The sex distribution was 81.4 % male and 18.6 % female ; 42.9 % of injuries affected the right knee and 57.1 % the left knee . All the included patients were ordered a MRI , executed in five separate centres . All patients underwent arthroscopy by the author . Arthroscopic findings were the diagnostic reference . Clinical examination was accurate in 91.4 % , and  MRI  in 88.5 % of anterior cruciate ligament injuries . For posterior cruciate ligament injuries , clinical accuracy was 100 % and MRI 94.6 % . Clinical examination was accurate in 96.9 % and  MRI  in 85.9 % of medial meniscal injuries . For lateral meniscus injuries , clinical accuracy was 85.4 % and MRI 73.8 % . MRI findings showed the lowest correlation with arthroscopic findings in lateral meniscus injuries ( r = 0/47 ) . Clinical diagnostic performance was poorest in case of combined cruciate ligament and meniscal injuries . We found an excellent correlation between  MRI and clinical findings . However , when MRI is normal , high clinical suspicion and a skilled clinical examination are more reliable Abstract Although magnetic resonance imaging ( MRI ) has improved the diagnostic accuracy of meniscal pathology , the authors believe that physical examination remains essential to the evaluation of knee pathology . In this study , the diagnostic accuracy of five clinical tests for meniscal pathology was prospect ively evaluated in 160 patients , who thereafter underwent arthroscopy .  69 % ( 109 knees ) of the knees tested had associated ACL deficiency . There were 144 meniscal lesions in 130 of the 160 knees which were examined . The sensitivity of the tests was lower than the specificity . Conventional tests such as McMurray and Apley tests showed a low accuracy rate of 45 % and 28 % respectively . The diagnostic value of the axially loaded pivot shift test was significantly higher , indicating that this remains a useful diagnostic aid . Résumé Ils évaluent prospect ivement la précision diagnostique de cinq différentes épreuves cliniques employées pour confirmer des déchirures méniscales chez des 160 sujets ayant subi une évaluation arthroscopique . Soixante – neuf pour cent ( 109 ) des genoux contrôlés par les auteurs présentaient une carence arthrocinétique complexe . Ils ont observé 144 déchirures méniscales sur 130 genoux . Toutes les épreuves cliniques présentaient généralement une sensibilité inférieure à leur spécificité . Quant au test de déplacement du pivot sous charge axiale , le fait que sa valeur diagnostique est , dans l’ensemble , significativement supérieure à celle des autres manoeuvres diagnostiques en fait un supplément de choix dans l’arsenal diagnostique This study evaluated the predictability of clinical examination alone in comparison with magnetic resonance imaging in the diagnosis of meniscal tears in competitive athletes . Ninety-three competitive athletes were prospect ively investigated between 1992 and 1995 . A total of 57 athletes were operated on based on clinical examination alone , and the 36 remaining athletes had magnetic resonance imaging before surgery . The correct diagnosis of a meniscal lesion was made on clinical examination alone in 83 athletes ( 89 % ) and on magnetic resonance imaging the correct diagnosis was also made in 89 % of 36 athletes . The overall values for the clinical investigation of the medial and lateral menisci combined were 94.5 % , 91.5 % , 99 % , 96.5 % , 87 % for accuracy , positive predictive value , negative predictive value , sensitivity , and specificity , respectively . The overall values for magnetic resonance imaging of the medial and lateral menisci combined were 95.5 % , 96.5 % , 91.5 % , 98 % , 85.5 % for accuracy , positive predictive value , negative predictive value , sensitivity , and specificity , respectively Previous investigations with plain radiography , myelography , and computed tomography have shown that degenerative disease of the cervical spine frequently occurs in the absence of clinical symptoms . We studied the magnetic resonance-imaging scans of sixty-three volunteers who had no history of symptoms indicative of cervical disease . The scans were mixed r and omly with thirty-seven scans of patients who had a symptomatic lesion of the cervical spine , and all of the scans were interpreted independently by three neuroradiologists . The scans were interpreted as demonstrating an abnormality in 19 per cent of the asymptomatic subjects : 14 per cent of those who were less than forty years old and 28 per cent of those who were older than forty . Of the subjects who were less than forty , 10 per cent had a herniated nucleus pulposus and 4 per cent had foraminal stenosis . Of the subjects who were older than forty , 5 per cent had a herniated nucleus pulposus ; 3 per cent , bulging of the disc ; and 20 per cent , foraminal stenosis . Narrowing of a disc space , degeneration of a disc , spurs , or compression of the cord were also recorded . The disc was degenerated or narrowed at one level or more in 25 per cent of the subjects who were less than forty years old and in almost 60 per cent of those who were older than forty . The prevalence of abnormal magnetic-resonance images of the cervical spine as related to age in asymptomatic individuals emphasizes the dangers of predicating operative decisions on diagnostic tests without precisely matching those findings with clinical signs and symptoms OBJECTIVE To determine clinicians ' accuracy and reliability for the clinical diagnosis of unstable meniscus 
    Output:
    
The accuracy of the special tests to diagnose meniscal tears remains poor .