Accuracy of modified Akmese’s test for diagnosis of posterior horn medial meniscus root tear

Objectives: Early diagnosis and treatment of posterior horn medial meniscus root tears (PHMMRTs) are critical to prevent accelerated knee osteoarthritis. While magnetic resonance imaging (MRI) is the gold standard for diagnosing PHMMRT, its routine use for all knee pain patients is not cost-effective. The Akmese’s test, based on tenderness at the posteromedial joint line that decreases at higher knee flexion angles (>90°) compared to extension, is a sensitive and specific diagnostic tool. We modified this test by adding a step to confirm reduced pain during knee extension. Although the test shows high sensitivity and specificity, its utility as a screening tool remains unstudied. This study aims to assess the diagnostic accuracy of the modified Akmese’s test to determine its effectiveness as a screening tool for guiding MRI use in patients with suspected PHMMRT. Materials and Methods: A total of 82 patients aged 18–55 diagnosed with medial meniscal lesions on MRI and scheduled for arthroscopic surgery were included. Patients with lateral meniscus tears, ligament injuries, or mucoid degeneration of the anterior cruciate ligament on MRI were excluded from the study. Eligible patients were evaluated for the modified Akmese’s sign, and findings were documented. A fellowship-trained surgeon, blinded to the result of the modified Akmese’s test, performed diagnostic arthroscopy and recorded the status of the posterior horn of the medial meniscus. Considering arthroscopy as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the modified Akmese’s test and MRI were calculated. Results were reported as numbers and percentages. Continuous variables were expressed as mean ± standard deviation. Results: The accuracy of the modified Akmese’s test to diagnose PHMMRT was 93.9% with 94.5% sensitivity, 93.3% specificity, and a receiver operating characteristic area under the curve of 0.935. The accuracy of MRI in diagnosing was 87.8% with a sensitivity of 75.6% and a specificity of 97.7%. Conclusion: The modified Akmese’s test is a simple, reliable, and highly sensitive test for detecting medial meniscus posterior root tears, making it a useful screening tool to determine the necessity of MRI in outpatient care.