A Multimodal Diagnostic Algorithm for Focal Knee Chondral Defects: Correlating Clinical Tests, Musculoskeletal Ultrasound, and MRI-Based ICRS Grading

Symptom severity alone does not reliably distinguish between ICRS Grade 3 and Grade 4 focal chondral lesions. McMurray's test, while not cartilage-specific, was associated with lesion complexity due to its reflection of concomitant meniscal pathology rather than cartilage depth itself. Accordingly, McMurray's test should be interpreted as an indirect clinical indicator of combined osteochondral-meniscal involvement. The integration of targeted clinical tests (Wilson's and McMurray's), MSK-US and MRI-based ICRS grading may support clinical orientation and preoperative risk stratification, forming a pragmatic diagnostic framework rather than a definitive staging tool.