The McMurray test is a hands-on clinical examination used to detect torn meniscus cartilage in the knee. Developed in 1928 by the British surgeon Thomas Porter McMurray, it remains one of the most commonly performed special tests in orthopedic and sports medicine clinics. The test is generally better at confirming a meniscal tear when the result is positive than it is at ruling one out when negative, a pattern that has practical consequences for how clinicians use it and how patients should interpret the result.
How the Test Is Performed
McMurray originally described a maneuver in which the knee is fully bent so the heel rests against or near the buttock. The examiner grasps the ankle with one hand while the other hand cups the knee joint, with the thumb and forefinger positioned on either side along the joint line toward the back of the knee. From that fully flexed position, the examiner rotates the shin bone inward or outward while slowly straightening the knee.1SciTechnol. The McMurray’s Test-A Historical Perspective – Section: The Classic History of McMurray Test The idea is to trap a torn flap of meniscus between the bones of the joint as the knee extends, producing a telltale sign the examiner can feel or hear.
In practice, the test is usually done with you lying on your back on an exam table. The clinician will bend your knee as far as it comfortably goes, then twist and extend it in a controlled arc. The whole thing takes less than a minute per knee. Although the original description called for maximal flexion, many clinicians today use a slightly less extreme range, partly because some patients cannot tolerate full flexion and partly because variations on the technique have become widespread.
What Counts as a Positive Result
A positive McMurray test is defined by the presence of pain along the joint line, a palpable or audible click, snap, or thud, or some combination of these during the rotation-extension maneuver.2PubMed Central. McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate? – Section: Materials and Methods Not all positive findings carry the same weight. A prospective study that compared the McMurray test directly against arthroscopic surgery found that the only sign with a statistically meaningful correlation to a confirmed medial meniscal tear was a distinct “thud” felt along the medial joint line. That thud was highly specific (about 98%) but had a sensitivity of only 16%, meaning the examiner could be quite confident a tear was present when the thud appeared but would miss many tears that did not produce one.3PubMed. Prospective evaluation of the McMurray test
Pain alone during the maneuver is a softer finding. Some clinicians count it as a positive result, others insist on a mechanical sign like a click or clunk. This disagreement about what constitutes “positive” is one reason the test’s reported accuracy varies so much from study to study. If a study defines positive as any pain during the maneuver, it will catch more true tears but also more false alarms. If it requires a clear mechanical pop, it will miss more tears but rarely call one when none exists.
The Core Accuracy Pattern
Across a wide body of research, the McMurray test consistently shows relatively high specificity and low sensitivity. In plain terms, a positive result is fairly trustworthy, but a negative result does not reliably clear you. An older review of the literature noted that studies evaluating the classically described version of the test yield sensitivity estimates around 26% with specificity around 94%.4Journal of Orthopaedic & Sports Physical Therapy. A review of the McMurray test: definition, interpretation, and clinical usefulness A widely cited review in primary care medicine reported a sensitivity of about 52% and a specificity of 97%.5PubMed. Evaluation of acute knee pain in primary care
More recent individual studies report a broader range. One study of 100 patients using MRI as the reference standard found the McMurray test had 63% sensitivity and 82% specificity for medial meniscal tears.6Pakistan Journal of Medical and Health Sciences. Magnetic Resonance Imaging Validates the Clinical Accuracy of the Mcmurray’s Test in Diagnosing Medial Meniscal Tears – Section: Results Another study found sensitivity of about 61% and specificity of about 62% for medial tears, with considerably higher accuracy for lateral tears (about 92% accuracy overall).7PubMed Central. Diagnostic Accuracy of McMurray’s Test for Meniscal Injury of the Knee Joint, Taking Arthroscopy as the Gold Standard – Section: Results A case series looking specifically at patients who also had torn ACL ligaments reported McMurray sensitivity of 80% for the medial meniscus and about 69% for the lateral meniscus.8International Journal of Surgery Case Reports. Diagnostic value of clinical tests and Mri for meniscal injury in patients with anterior cruciate ligament injury: Case series study – Section: Abstract
The takeaway from this spread is that the numbers shift depending on the patient population, how strictly the examiner defines a positive test, and whether the “gold standard” comparison is MRI or arthroscopic surgery. But the basic shape of the finding holds: if the McMurray test is clearly positive, a meniscal tear is likely there. If it is negative, you cannot assume the meniscus is intact.
How It Compares to Other Physical Exam Tests
The McMurray test is almost never used in isolation. Clinicians typically combine it with other maneuvers, the most common being joint line tenderness (pressing along the knee joint line to check for pain) and the Thessaly test (standing on the affected leg with the knee slightly bent and twisting). Each test has a different strengths profile.
A comparative study using both MRI and arthroscopy as reference standards found that for medial meniscal tears confirmed by arthroscopy, the Thessaly test was the most sensitive at about 77%, while the McMurray test and joint line tenderness were more specific (both around 81%). For lateral meniscal tears, the McMurray test showed the highest agreement with arthroscopic findings overall.9PubMed Central. Comparison of Thessaly Test with Joint Line Tenderness and McMurray Test in the Diagnosis of Meniscal Tears – Section: Results Another prospective cohort study found the Thessaly test to be both more sensitive and more specific than the McMurray test for both medial and lateral meniscal injuries, with Thessaly sensitivity exceeding 92% and McMurray sensitivity around 84%.10Journal of Arthroscopy and Joint Surgery. Correlation between Clinical Examination, Magnetic Resonance Imaging, and Arthroscopy in Meniscal Injuries of the Knee: A Prospective Cohort Study – Section: Results
Joint line tenderness tends to be more sensitive than the McMurray test but substantially less specific, meaning it catches more tears at the cost of more false positives. One review put joint line tenderness sensitivity at 75% with specificity of only 27%, compared to the McMurray test’s 52% sensitivity and 97% specificity.11PubMed. Evaluation of acute knee pain in primary care So the two tests complement each other nicely: joint line tenderness casts a wide net, while a positive McMurray helps confirm the catch.
Combining tests does not always boost accuracy as much as you might expect. When the Thessaly and McMurray tests were both positive in one study, the combined sensitivity was only 53% with specificity of 62%, numbers that are not dramatically better than either test alone.12PubMed. Validity of the Thessaly test in evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy study – Section: RESULTS The clinical reality is that no single physical exam maneuver or even combination of maneuvers replaces imaging when a definitive answer is needed.
When the McMurray Test Is Less Reliable
One important scenario that muddies the picture is when a meniscal tear occurs alongside a torn anterior cruciate ligament, or ACL. In knees with combined ACL and meniscal injuries, the McMurray test was positive in about 82% of cases, compared to only 62% in knees with isolated meniscal tears.13Acta Orthopaedica et Traumatologica Turcica. The accuracy of the clinical diagnosis of meniscal tears with or without associated anterior cruciate ligament tears – Section: Abstract That might seem like good news, but the same study concluded that the overall clinical accuracy of diagnosing a meniscal tear actually decreases when an ACL tear is also present. The increased knee laxity from a blown ACL can generate abnormal motion and mechanical signs that mimic or mask meniscal findings, making interpretation harder.
The type of meniscal tear also matters. The original McMurray test was designed to catch tears in the posterior horn of the meniscus, the section toward the back of the knee. Tears in the anterior horn or body of the meniscus may not get trapped between the bones during the rotation-extension maneuver, so they are more likely to produce a false-negative result. And degenerative tears, which are more common in middle-aged and older adults, behave differently from acute traumatic tears in younger patients. Research on distinguishing these two types has found that combining patient history (such as whether pain started after a pivoting injury versus came on gradually) with specific exam findings like medial joint line tenderness may be more useful than the McMurray test alone for classifying the tear type.14PubMed Central / Elsevier. Diagnostic Validity of Combining History Elements and Physical Examination Tests for Traumatic and Degenerative Symptomatic Meniscal Tears – Section: RESULTS
The Role of MRI and Why It Doesn’t Replace the Exam
MRI is the standard non-invasive imaging test for meniscal tears, and across most studies its sensitivity and specificity both exceed 85%. In one prospective cohort study, MRI sensitivity for the medial meniscus was about 95% and specificity around 94%.15Journal of Arthroscopy and Joint Surgery. Correlation between Clinical Examination, Magnetic Resonance Imaging, and Arthroscopy in Meniscal Injuries of the Knee: A Prospective Cohort Study – Section: Results Those numbers clearly outperform any physical exam test used alone.
Still, MRI has its own limitations. It can overcall tears, especially small degenerative signal changes that do not cause symptoms. It is expensive, not always immediately available, and in many healthcare systems requires authorization and scheduling delays. This is exactly why physical examination tests like the McMurray maneuver persist. When combined with MRI, the McMurray test contributed to a diagnostic accuracy of roughly 89% for meniscal tears, with sensitivity climbing above 97%.16Swiss Medical Weekly. Predicted probability of meniscus tears: comparing history and physical examination with MRI – Section: Results In other words, combining a thorough clinical exam with imaging produces better decisions than either one alone. Clinicians use the McMurray test as a first-pass screening tool to decide whether imaging is warranted, and then as a cross-check against what the MRI shows.
Examiner Variability and Interobserver Agreement
One underappreciated issue with the McMurray test is how much the result depends on who is performing it. Feeling a subtle click or thud through a knee joint is inherently subjective, and different examiners can disagree on what they felt. The prospective study that isolated the medial “thud” as the only reliable sign reported only fair interobserver agreement, with a kappa statistic of 0.35.17PubMed. Prospective evaluation of the McMurray test A separate study found that interobserver concordance for the McMurray test was higher than for joint line tenderness, but that concordance improved when the less experienced examiner’s readings were removed from the analysis.18PubMed. Joint line tenderness and McMurray tests for the detection of meniscal lesions: what is their real diagnostic value? – Section: Results
That finding about experience is worth noting. While the prospective arthroscopy comparison study found that examiner experience had little effect on overall diagnostic accuracy for medial meniscal tears, the concordance data suggest that experienced examiners agree with each other more often than novice examiners do. The test itself may be somewhat skill-dependent even if the bottom-line accuracy numbers remain similar across experience levels.
Modified Versions of the Test
Because of the McMurray test’s well-known sensitivity limitations, clinicians and researchers have developed several modifications. These typically alter the starting position, the range of motion used, or the type of force applied. Some versions use a valgus (inward) or varus (outward) stress on the knee during rotation, while others start from a less extreme degree of flexion. A systematic review of the literature found that modified versions of the McMurray test generally had higher overall diagnostic accuracy than the classic version, suggesting that the original technique as McMurray described it in 1928 may not be the most effective form of the maneuver.19PubMed Central. Validity of the McMurray’s Test and Modified Versions of the Test: A Systematic Literature Review – Section: Abstract
The challenge is that modified tests are described inconsistently in the research literature. What one group calls a “modified McMurray” may differ substantially from another group’s version, making it hard to compare results across studies. This variation also means that when a clinician tells you “the McMurray test was positive,” the specific maneuver performed could have differed from what another clinician would do. Standardization remains an ongoing problem in meniscal physical examination research.
What to Expect If Your Clinician Performs It
If you are being evaluated for a possible meniscal tear, the McMurray test is likely to be one part of a broader knee exam that also includes checking for joint line tenderness, ligament stability, range of motion, and swelling. The test itself can be uncomfortable, especially if you do have a tear. The rotation and extension of a knee that is already irritated can reproduce the catching or locking sensation you may have noticed during daily activities. That discomfort, while unpleasant, is informative because it is part of what the examiner is assessing.
A positive McMurray result, particularly when combined with tenderness along the joint line and a history consistent with a meniscal injury (such as a twisting episode, locking, or catching in the knee), will often prompt a referral for MRI. A negative result does not necessarily mean your meniscus is fine. Given the test’s known sensitivity gap, a clinician who still suspects a tear based on your history and other exam findings may recommend imaging anyway. The McMurray test helps raise or lower suspicion, but it is a clinical tool in a larger decision process, not a standalone verdict.
Virtual and Telemedicine Knee Exams
The expansion of telemedicine during and after the pandemic raised the question of which orthopedic tests can translate to a video visit. The McMurray test, which requires the clinician to physically manipulate your knee while feeling for mechanical signs, is essentially impossible to replicate remotely. A review of virtual orthopedic examination noted that some tests, such as the Thessaly test performed at 20 degrees of knee flexion, can be guided verbally and demonstrated by the patient at home because they involve self-performed movements.20JBJS Reviews. Virtual Orthopaedic Examination of the Lower Extremity – Section: Abstract A scoping review of video-based knee examinations found that while components like range of motion and certain functional tests could be assessed remotely with reasonable reliability, hands-on provocative tests like the McMurray were largely excluded from virtual protocols.21JOSPT Open. Video-Based Musculoskeletal Knee Examination – A Scoping Review – Section: Abstract
If you are being evaluated for knee pain via telehealth, the clinician may use the Thessaly test or functional squat as a substitute screening maneuver, but a definitive meniscal assessment will likely still require an in-person visit. The McMurray test’s reliance on the examiner’s hands is both its strength and its limitation in an increasingly digital healthcare landscape.