Meniscal tests: McMurray and Apley !

Maneuver

Bending and twisting the knee while feeling the joint line can produce a painful click when a meniscus is torn.

Updated 2026-11-01

See it in 3D: Medial meniscus · Lateral meniscus · Femur · Tibia · MCL

What it is

The McMurray test traps the posterior horn of the menisci between the femur and tibia with full flexion, rotation and extension; a torn fragment produces a painful click at the joint line. The Apley test compresses and rotates the knee with the patient prone. They are the classic maneuvers for meniscal tear, common in young athletes and, through degeneration, in older adults.

The anatomy it tests

The menisci are two crescent-shaped fibrocartilages between the femoral condyles and the tibial plateau; they spread the load and steady the knee.
The medial meniscus is C-shaped, attached to the capsule and the medial collateral ligament, moves less and tears more.
The lateral meniscus is more circular and more mobile.
Full flexion with rotation traps the posterior horn between femur and tibia; on extension, a torn fragment shifts and makes the click.

How to do it

Patient supine; the examiner stands on the side being tested.
One hand holds the knee with the fingers on the medial and lateral joint lines; the other holds the heel.
Flex the knee fully.
Medial meniscus: rotate the tibia outward (foot out), apply valgus and slowly extend the knee.
Lateral meniscus: rotate the tibia inward, apply varus and extend the knee.
Positive McMurray: a palpable or audible click at the joint line, with pain that reproduces the patient's symptom.
Apley: patient prone with the knee at 90 degrees; the examiner fixes the thigh and pushes the foot down toward the table while rotating the tibia.
Apley positive on compression: joint line pain. Then pull the foot upward while rotating: pain this way points to ligaments.

What a positive result means

Pain and click at the medial joint line: medial meniscus tear; at the lateral line: lateral meniscus tear.
Accompanying symptoms: locking (cannot fully straighten), a catching feeling and swelling that develops hours later.
In young people the tear follows a twist on a flexed, loaded knee; in older people it is degenerative, after minor trauma.
Joint line tenderness on its own helps little.
A negative McMurray does not rule out a tear.

Usefulness and limits

A positive McMurray is one of the most useful findings to confirm a tear, but its sensitivity is low.
In the acute knee, pain and effusion prevent the full flexion the test needs.
MRI confirms the tear and its type.

Test yourself

Think of the answer, then tap the question to see it.

Which combination of movements tests the medial meniscus in the McMurray test?

Full flexion, external rotation of the tibia and valgus, followed by slow extension of the knee.

What counts as a positive McMurray test?

A palpable or audible click at the joint line with pain that reproduces the patient's symptom.

Why is the medial meniscus injured more often than the lateral?

Because it is attached to the capsule and the medial collateral ligament, is less mobile and gets trapped more easily.

How does the Apley test separate a meniscal from a ligament injury?

Pain with compression and rotation suggests the meniscus; pain with distraction and rotation suggests a ligament.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Evaluating the Patient with a Knee Injury (American Family Physician (American Academy of Family Physicians), 2005); Musculo-Skeletal Examination – Knee Exam (UC San Diego School of Medicine, Practical Guide to Clinical Medicine, 2026).

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Representative model, for educational purposes only.