Apley Compression Test: Meniscal Tear Test

Introduction to the Apley Compression Test

The Apley Compression Test is the specific orthopedic tests that is used to check a possible involvement of the menisci of the knee joint. AC is a vital differential diagnosing tool for physiotherapists, osteo-articular specialists and the sports medicine practitioners with invaluable information on knee pathology. The test is performed in order to learn the presence of meniscal injuries as the load puts pressure on the knee joint and rotates it.

It is especially helpful in differentiation of ligamentous and meniscal injuries of the knee, in those patients who present acute pain after a trauma, or those who have a history of recurrent pain during physical exercise. Hence knowledge and right performance of this test is important on determination of the need for further investigations, imaging, or referral to rehabilitation.

Diagnosing Meniscal Injuries

• The Apley Compression Test has main application and it is intended for the confirmation of the meniscus trauma of the knee only. Athletes, as well as people who engage in extremely physically demanding disciplines like soccer, basketball or skiing often suffer from meniscal tears but they can be present in patients with other knee disorders as well.
• Menisci are the semi-lunar fibrocartilage discs which act as the cushion like pads at between the femur and the tibia. They have an important function of balancing load across the knee joint as well as to enhance the movement. Knee disorders that may result from meniscus damage include pain, knee swelling and instability of the knee joint. The Apley Compression Test is used to determine whether or not these cartilaginous structures have been damaged so that treatment approaches such as periodic immobilization or surgery can be recommended.

Anatomy Involved in the Apley Compression Test

The  Apley Compression Test, focuses on the following anatomical parts; Menisci is present in between the femur and the tibia in the knee joint. There are two menisci in each knee: two types: the medial meniscus, and the lateral meniscus. Both serve the purpose of shock absorption during load bearing and for precise positioning of limbs for load bearing and it also help to smoothen the frictional forces between the bones and cartilages of underlying joints.

Other important structures relevant to the Apley Compression Test include:

The Tibiofemoral Joint: The area in which the tibia and the femur meet or connect is called knee joint, and the center of the knee joint which contains the menisci is called the knee cap or patella.

Collateral Ligaments: Most this involvement is with the medial and lateral collateral ligaments, which help to control the knee joint and could also be involved indirectly when performing the test.

Joint Capsule and Articular Cartilage: These structures can also be implicated in situations involving osteoarthritis or other chronic knee related diseases which makes it difficult to explain test results.

Indications for the Apley Compression Test

When performing the Apley Compression Test, the clinician can do so in a number of clinical conditions which include; the following steps are followed when applying the test. It is often done in the knee complaints such as pain, swelling, restricted movement, or giving out sensation around the knee joint usually precipitated by trauma or overuse. The test is useful in acute injuries and chronic degenerative processes Test is useful in both acute and chronic settings.

Suspected Meniscal Tears

Meniscal tears are the most common reason people are subjected to Apley Compression Test. Such injuries usually occur when there is a twisting or a rotatory force on a flexed knee and some of them include running, squatting, or jumping. Most patients with meniscal tears present with pain, increased joint stiffness, joint locking, or a feeling of the knee ‘giving way’.

Post-Trauma Knee Evaluation

After any knee injury including falls, sportman like activities and auto-mobile related injuries the Apley Compression Test assists in determining whether or not the menisci are lesioned as well as probably the ligaments.

Gradual Degenerative Disorders of the Knee Joint (e. g. Osteoarthritis)

In patients with degenerative knee conditions as in osteoarthritis, the menisci are subjected to wear and tear and cause pain and dysfunction. It is important to recognize the value of Apley’s compression test as relevant in assessment of meniscal degenerative changes and assessing equivalence of meniscectomy.

The test can be used to differentiate between meniscal injuries and ligamentous injury such as complete tear of the anterior cruciate ligament or medial collateral ligament whose presentation may be similar to that of meniscal injury.

How to Perform the Apley Compression Test: Step-by-Step Guide

Some consideration should be taken before executing the Apley Compression Test as it involves certain specific positioning of the patient and the therapist. Below is a detailed guide on how to perform the test:

Patient Positioning

The position that the patient assumes is prone (face down position) on the examination table.

In this position the descriptive left knee of the affected side should be flexed to 90 degrees and the lower leg should be parallel to the table surface.

It is also important to isolate contraction  of the foot muscles in order not to count seconds from other muscle contraction.

Therapist Positioning

The position that the physiotherapist takes is standing to the side of the patients at the knee level of the patient.

The therapist should put one of his/her hands over the heel or the plantar aspect of the foot which will prevent the tibial movement and with the other hand, the therapist may place it over the posterior thigh.

Performing the Test

1. Compression: Through the patient’s heel, the therapist gently pushes downwards towards the knee joint of the patient in order to compress the menisci with the tibia and femur.
2. Rotation: Although the downward pressure is being applied, the therapist rotates the tibia internally and externally. Lateral meniscus is subjected to stress in internal rotation while the medial meniscus is subjected to stress in external rotation.

The test is administered several times and while administering the test particular attention is paid to the reaction of the patient.

Outcome Measures of the Apley Compression Test

Positive Test

During Apley Compression Test, positive sign is the signs of pain or even a click that is felt when applying the compression and rotation at Knee joint. Pain typically suggests a meniscal tear; the specific meniscus – the direction of rotation: internal, for the lateral; external for the medial. Other symptoms which may be described include a sensation of ‘catching’ which would also point to a diagnosis of a meniscal injury.

Negative Test

A negative test result on the other hand is when the person experiences no pain or discomfort during the test implying that the menisci are normally present. But, an abnormality does not entirely exclude meniscal pathology, particularly if the symptoms are intermittent, or if the test was administered early on when swelling or pain would mask the result.

Differential Diagnosis with the Apley Compression Test

Several conditions can present similarly to meniscal injuries, and the Apley Compression Test can help distinguish between them:

1. Ligamentous Injuries (e. g. , ACL, MCL): The following injuries are for the most part evaluated by the use of tests like Lachman or Valgus/Varus stress examination. However, these ACL injuries may result in pain when touching knee such movements and this may sometimes complicate the test.
2. Osteoarthritis: The joint changes in patients with osteoarthritis might have pain and stiffness which will imitate a meniscal tear. Apley Distraction test, which is done alongside the Apley compression test can assist in the differentiation of meniscal from ligamentous or joint lesion.
3. Chondromalacia Patellae: This involves the cartilage under the kneecap and may cause anterior knee pain which may be mistaken to be as a result of meniscal injuries.
4. Patellar Tendinopathy: The patient’s with patellar tendinopathy can complain of anterior knee pain, covering the symptoms of meniscal injury, during the knee flexion and weight-bearing exercises.

Related Tests to the Apley Compression Test

Other orthopedic tests are often performed alongside the Apley Compression Test to increase diagnostic accuracy and assess for additional knee pathologies:

1. McMurray Test: Another test which is used when the knee is flexed and is rotated while extending and usually produces an audible sound if the meniscus is damaged.
2. Thessaly Test: There is a dynamic test applied when diagnosing meniscal tears which is done in a weight-bearing fashion by having the patient stand on one leg and rotate the affected knee.
3. Lachman Test: Mainly employed in evaluating integrity of ACL, it can also exclude ligamentous injuries, which may have similar clinical presentation.
4. Apley Distraction Test: Normally done after Apley Compression Test, in which there is a traction and rotation on the tibia. If the pain decreases during distraction then it is most likely a meniscal tear rather than a ligamentous one.

Conclusion

The Apley Compression Test continues to be a very useful test in the armamentarium of physiotherapists when evaluating meniscal injuries of the knee. Meniscal pathology is complicated in that the combination of compression and rotational force is useful in differentiating between meniscal disease and ligamentous or joint capsule injury. Employing the proper technique in performing this procedure, knowledge of knee anatomy, and performance of other related tests will enable one to arrive at proper conclusions when diagnosing and formulating effective treatment plans.

FAQs

What is the use of Apley’s Compression Test in any clinical assessment?

The Apley Compression Test is mainly used on knee injuries particularly for the detection of a meniscal injury.

Does the Apley Compression Test cause pain?

If there is a meniscal tear, it can lead to pain or discomfort that is most likely to be seen when the structures are compressed or twisted.

Can the Apley Compression Test be used with ligament injury?

Even though it is targeted directly to menisci, its combination with other tests separate at times between meniscal and ligamentous injuries.One may ask how reliable the Apley Compression Test actually is because of its relative simplicity.The test is significant when used in conjunction with other tests such as the McMurray Test, and other imaging techniques including MRI.

What is the sequela of a Positive Apley Compression Test?

If positive they may need further imaging such as an MRI or be referred to a specialist for possible surgery.