Apley’s Test

Also known as	Apley’s compression test, Apley’s grind test
Structure tested	Medial and lateral menisci; collateral ligaments
Patient position	Prone, knee flexed to 90°
Positive sign	Pain with compression suggests meniscal injury; pain with distraction suggests ligamentous injury
Sensitivity	~84%
Specificity	~71%

What Is Apley’s Test?

Apley’s test is an orthopedic special test used to evaluate for meniscal injury and to differentiate meniscal pathology from ligamentous injury at the knee. It is unique among knee special tests in that it includes both a compression phase and a distraction phase, with the pattern of pain between the two phases guiding interpretation.

The test is performed in the prone position with the knee at 90° flexion. This position allows the examiner to apply axial load and rotation (compression phase) to stress the menisci, then switch to distraction and rotation to unload the menisci and stress the collateral ligaments instead.

Anatomy: The Menisci

The medial and lateral menisci are C-shaped fibrocartilaginous structures that sit between the femoral condyles and the tibial plateau. They improve joint congruence, distribute load across the knee, and contribute to stability and shock absorption.

The medial meniscus is more firmly attached to the joint capsule and the MCL, making it less mobile and more vulnerable to injury — particularly with combined valgus and rotational forces. The lateral meniscus is more mobile and less commonly torn in isolation.

Involved Structures

• Medial meniscus
• Lateral meniscus
• Medial collateral ligament (MCL) — assessed during distraction phase
• Lateral collateral ligament (LCL) — assessed during distraction phase

How to Perform Apley’s Test

Starting Position

Position the patient prone on the examination table. Flex the knee to 90°. To stabilize the thigh and prevent hip movement, place your knee across the posterior thigh of the patient’s leg being tested — this is the classic stabilization technique that gives the examiner firm control while applying force through the foot and ankle.

Compression Phase (Apley’s Grind Test)

Apply a downward axial force through the patient’s heel, compressing the tibia into the femur. While maintaining compression, rotate the tibia internally and externally. This loads the menisci between the tibial plateau and femoral condyles.

Pain reproduced during the compression and rotation phase suggests meniscal pathology.

Distraction Phase

Without repositioning the patient, switch to an upward force — lifting the tibia away from the femur — while again rotating the tibia internally and externally. This unloads the menisci and instead stresses the collateral ligaments and joint capsule.

Pain reproduced during the distraction and rotation phase suggests ligamentous injury rather than meniscal pathology.

Positive Sign and Interpretation

Finding	Interpretation
Pain with compression + rotation	Meniscal pathology likely
Pain with distraction + rotation	Ligamentous injury likely (MCL, LCL, capsule)
Pain with both phases	Possible combined injury; requires further assessment
Pain with neither phase	Meniscal and ligamentous pathology less likely

The compression vs. distraction differential is the key clinical feature of this test — it is what distinguishes Apley’s from other meniscal tests that only apply one type of force.

Sensitivity and Specificity

Metric	Value
Sensitivity	~84%
Specificity	~71%
Positive likelihood ratio (LR+)	~2.9
Negative likelihood ratio (LR−)	~0.2

A positive LR of ~2.9 represents a moderate shift in post-test probability — useful but not definitive. A negative LR of ~0.2 means a negative test provides a meaningful reduction in the probability of meniscal injury. As with all meniscal tests, accuracy improves when multiple tests are used together alongside clinical history.

Apley’s vs. McMurray Test

Both tests assess for meniscal pathology through rotation under load, but they differ in position and what they add:

• McMurray Test is performed in the supine position and involves a valgus or varus force combined with rotation at varying degrees of flexion. It is the more commonly used test and has a larger evidence base.
• Apley’s Test is performed prone and includes the distraction phase, which allows differentiation of meniscal from ligamentous pathology in the same examination sequence — a practical advantage when both structures are suspect.
• The prone position of Apley’s is also useful for patients who cannot tolerate the side-lying or supine positioning required for McMurray.

Clinical Considerations

• Use with other tests: No single meniscal test is highly accurate in isolation. Combining Apley’s with the McMurray test and Thessaly test improves diagnostic confidence.
• Thigh stabilization matters: Inadequate stabilization of the thigh allows hip movement to compensate and reduces the force transmitted to the knee — lowering test reliability. The classic technique of placing your knee on the patient’s posterior thigh is the most reliable method.
• Acute injuries: Pain and swelling can limit both positioning and patient tolerance. Apply forces gradually and avoid forcing the knee into 90° if acute effusion is present.
• Pain location: Medial joint line pain during the compression phase suggests medial meniscus involvement; lateral joint line pain suggests the lateral meniscus.

Related Knee Tests

• McMurray Test — The most widely used meniscal test; supine position
• Thessaly Test — Weight-bearing meniscal screen at 20° flexion
• Bounce Home Test — Screens for extension block from meniscal tear or loose body
• Lachman Test — ACL integrity; often assessed in the same examination

Frequently Asked Questions

What does pain during the compression phase of Apley’s test indicate?

Pain during the compression and rotation phase suggests the meniscus is being pinched between the tibial and femoral surfaces — indicating meniscal pathology. The examiner can further localize by noting whether pain is on the medial or lateral joint line.

Why is the distraction phase important?

The distraction phase unloads the menisci while still applying rotation, which stresses the collateral ligaments and joint capsule instead. Pain that is greater during distraction than compression suggests a ligamentous source rather than a meniscal one — a useful differential in cases where both structures may be involved.

Is Apley’s test accurate for diagnosing meniscal tears?

Apley’s has moderate diagnostic accuracy (~84% sensitivity, ~71% specificity). It is most useful as part of a cluster of meniscal tests rather than in isolation. A positive result increases the likelihood of meniscal pathology but should be interpreted alongside clinical history, joint line tenderness, and imaging when the diagnosis is uncertain.

Video Demonstration

>> Return to the list of Common Tests in Orthopaedic Examination of the Knee

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Here are some other articles you may be interested in:

• Introduction to Osteoarthritis of the Knee
• Lachman’s Test – for ACL integrity
• Bounce Home Test – for meniscus injury