Overview of Apley Grind Test
The Apley grind or compression test is a method that doctors use to examine the knee for any possible damage, particularly to the meniscus, which is a piece of cartilage that acts as a cushion between your shinbone and thighbone. This physical examination technique was first introduced by a British bone specialist named Alan Graham Apley. Often, doctors will use the Apley grind test together with another examination called the Apley distraction test.
Injuries to the meniscus are quite common and can lead to significant pain, disability, and time off from school, sports, or work. These types of injuries are very rare in children under ten years old. Males are more likely to have these injuries than females, probably because males often participate in more activities like contact sports that can cause rotation injuries to the knees.
The quick and proper diagnosis of these injuries is very important. Doctors will use physical examination, tests like the Apley grind test, the Apley distraction test, and advanced imaging techniques such as magnetic resonance imaging (MRI) to identify the injury. Understanding the problem thoroughly will help doctors to provide the correct treatment and ensure the best outcome for their patients.
Anatomy and Physiology of Apley Grind Test
The knee joint has two special features known as the lateral and medial menisci. Picture the meniscus like a small C-shaped cushion made up of a rubbery substance called cartilage. It’s tucked between the two bones that form the knee joint – the upper bone of your shin (proximal tibia) and the lower part of your thigh bone (distal femur). The meniscus is normally about the width of your thumb, and about as thick as a few stacked coins. It acts like a shock absorber within the knee to help cushion and reduce wear and tear on the joint. It’s mostly made up of collagen (the main support protein of the skin, tendons, and bones), special protein sugars called glycoproteins and proteoglycan, and water.
Three sets of ‘tie-like’ structures named ligaments help to hold the meniscus in place. The coronary ligaments join the outer edge of the meniscus to the knee. The transverse or inter-meniscal ligament is in the front of the knee and ties the two menisci together. The meniscofemoral ligament helps to link the meniscus to the large ligament in the back of the knee, called the posterior cruciate ligament or PCL, and has two smaller ligaments within it: the Humphrey ligament in the front and the ligament of Wrisberg in the back. The meniscofemoral ligament starts from the back part of the lateral meniscus.
Two arteries, the medial inferior genicular artery and the lateral inferior genicular artery, carry blood to the meniscus. However, the blood supply to the meniscus isn’t very rich, especially in the middle part, which relies mostly on a process called diffusion to get the nutrients it needs.
There are several different ways that the meniscus can tear. These include flap tears (imagine a flap on a box), radial tears (like the spoke of a bicycle wheel), horizontal cleavage tears (like a piece of wood being split), bucket handle tears, longitudinal tears (straight up and down), and degenerative tears (which happen over time due to wear and tear).
Why do People Need Apley Grind Test
You might have a meniscal injury if you’re feeling pain in your knee, especially after an incident where you twisted your knee while your foot was still touching the ground. This type of injury can occur whether or not an external force, like someone hitting your knee, was involved.
Typically, the pain from a meniscal injury is felt along the line of the knee joint. Many individuals experiencing a meniscal injury might complain about pain, as well as a feeling like their knee is catching or clicking. They might also have trouble fully extending their knee.
Meniscal injuries often happen at the same time as injuries to your ligaments. If you experience an external force to the outer part of your knee, you might suffer from what is known as an “unhappy triad.” This is a combination of injuries to the cushioning disc in your knee (medial or lateral meniscus), the main ligament inside your knee (anterior cruciate ligament or ACL), and the ligament that runs along the inside of your knee (medial collateral ligament or MCL).
If you go to a doctor for a physical examination, they might note tenderness along the joint line, fluid buildup in the joint, or a limited range of motion in your knee, as these are all common symptoms of meniscal injuries.
When a Person Should Avoid Apley Grind Test
The Apley grind test is a way doctors check for knee problems. However, this test isn’t recommended for people who have severe knee deformities. If someone has had a serious injury with a clear fracture or dislocation in the knee, it’s best to wait for the results of scans and x-rays before doing tests like the Apley grind and distraction tests. Also, for patients who have had amputations in the past, doctors must be extra careful and adjust the way they perform these tests.
Equipment used for Apley Grind Test
To carry out this test, you don’t need any specific equipment. All that’s required is a regular examination table.
Who is needed to perform Apley Grind Test?
This test is simple enough that it doesn’t need any additional staff. So, it will just be run by the doctor, with you, the patient, involved. That’s it – just two people are needed for this process: you and your healthcare provider.
Preparing for Apley Grind Test
The Apley grind test is a type of examination that a doctor may use to check for any issues in your knee. During this test, you will be asked to lie face down on the examination table, and you will be wearing a standard examination gown. The doctor will then carry out the test while you’re in this position. It’s a common and safe procedure that helps the doctor understand what may be causing any knee problems you might have.
How is Apley Grind Test performed
You will be positioned face down on an exam table for the evaluation of your knee’s condition. The doctor will bend the knee that’s being tested into a right angle while leaving the other leg straight, resting on the table. Your doctor will then apply a sideways and downward pressure on the foot of your bent leg while stabilizing your thigh with the other hand to compress your knee.
The doctor then rotates your foot inwards and outwards while also applying pressure. This is called the Apley compression test. If it causes pain or limits your movement, it may suggest an issue with your knee. For instance, if you feel pain on the inner side of your knee, that could suggest an injury to the medial meniscus, a type of cartilage in your knee that acts as a shock absorber. If the pain is on the outer side of your knee, that might mean an injury to the lateral meniscus, another protective cartilage in your knee.
The doctor may also conduct the Apley distraction test, which is intended to test for ligament injury rather than injury to the meniscus. This time, your doctor will pull your leg upwards, placing a strain on your knee ligaments. You may have a problem with your ligaments if this causes pain. This pain and the distraction make it less likely that you have a meniscus injury. It also reduces the force applied on your meniscus considerably.
Possible Complications of Apley Grind Test
According to medical reports, there are no known complications relating to a knee assessment known as the Apley compression test. It’s worth noting though, that during the test, you might experience some knee pain, which is normal. The presence of pain can in fact help doctors to determine whether or not the test results are positive.
However, if your knee has a significant deformity due to a major injury, it’s advised not to perform this test. It could lead to more serious problems, like making an existing break in the bone worse, or risking the initial break becoming an open fracture.
What Else Should I Know About Apley Grind Test?
A meniscal injury, which is a common knee injury, can be detected using a physical exam and provocative tests, such as the Apley compression and distraction tests along with advanced imaging like an MRI.
In terms of treatment, a combination of non-operative measures like medication and physical therapy is typically the first step for degenerative meniscal tears. These types of tears typically result from wear and tear over time. However, depending on the individual case, surgery may be necessary to repair the meniscus, which is a piece of cartilage that cushions and stabilizes the knee joint.
Keep in mind, though, that not all tears are suited for surgical repair. For instance, peripheral tears, which occur on the outer edges of the meniscus where a rich blood supply exists, are usually better candidates for surgical repair than some other types.
In evaluating meniscal injuries, recent studies have compared the effectiveness of various tests. One such study found that among the Apley compression test, McMurray test, and Thessaly test, the Thessaly test displayed the best performance with high sensitivity and specificity values. Sensitivity refers to the test’s ability to correctly identify positive cases, while specificity is the test’s ability to correctly identify negative cases.
Another test, the McMurray test, was found to be more specific for the detection of meniscal injuries, and particularly sensitive for medial meniscus tears according to another study.
Further research indicated that the Apley compression test is quite specific but less sensitive compared to the McMurray test. In another analysis, it was concluded that instead of relying on one test, it’s best to use a combination of tests to diagnose a meniscal tear.
These clinical tests may not be as helpful in identifying meniscal diseases when other knee conditions like anterior cruciate ligament pathology or chondromalacia (a condition where the cartilage under the kneecap deteriorates) are present.
