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assic fitness and health white logoassic fitness and health white logoKnee ExaminationKnee Examination

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Knee Examination

Categories
  • Examination
  • Knee
  • Knee Examination
  • Medical
Tags
  • Examination
  • Knee
  • knee examination
Knee Anatomy & Examination

Knee Examination

Human anatomy alignment

Knee Examination
Human anatomy alignment
Knee Examination
Human anatomy alignment

Knee muscle and tendon attachments

Knee muscle
Tendon attachments

Muscle and tendon attachments

Muscle and tendon attachments
Muscle and tendon attachments

Muscle attachments around knee allow knee range of motion (ROM)

Assess gait pattern

Assess gait pattern

Assess gait pattern while walking. Look at alignment and for any abnormal knee thrusting movements.

MCL

Knee Examination
MCL
Knee Examination

Apply a valgus force at 0° & 30 ° knee flexion

LCL

Knee Examination

Apply a varus force at 0° & 30 ° knee flexion

LCL tear

LCL tear

LCL tear on varus stress testing

Examine hip rotation and assess femoral neck version

Hip IR & ER

Knee Examination

Supine Gage

Knee Examination

Traditional femoral neck anteversion test is done in prone position

Anterior Cruciate Ligament (ACL)

Anterior Cruciate Ligament (ACL)

ACL tests

  • Lachman test
  • Anterior Drawer test
  • Pivot

Lachman test (View 1)

Knee Examination

Lachman test (View 2)

Knee Examination
Medial View of The Knee

Lachman test demonstrating torn ACL

Anterior Drawer Test

Anterior Drawer Test

Drawer Test

Anterior and posterior drawer tests: start test by first palpating the tibia in relation to the medial femoral condyle. Assess tibia position and ascertain if it is in an anatomical position before commencing with the Anterior and Posterior drawer tests.

Torn ACL

Anterior Drawer Test demonstrating torn ACL
Anterior and posterior drawer tests: start the test by first palpating the tibia in relation to the medial femoral condyle. Assess the tibia position and ascertain if it is in an anatomical position before commencing with the Anterior and Posterior drawer tests.

Pivot Test

Pivot Test

Posterior Cruciate Ligament (PCL)

Pivot Test
  • Observation: posterior sag, hyperextension
  • Posterior Drawer test
Pivot Test
Posterior Drawer Test

Posterior Drawer Test

Drawer Test

Anterior and posterior drawer tests: start the test by first palpating the tibia in relation to the medial femoral condyle. Assess the tibia position and ascertain if it is in an anatomical position before commencing with the Anterior and Posterior drawer tests.

Posterolateral Corner (PLC)

Knee Examination

PLC tests

  • Posterolateral drawer test
  • Dial test at 30°: positive if > 30° external rotation
  • Dial test at 90°: if positive combined PCL & PLC instability
  • External recurvatum test
  • Reverse Pivot test

Posterolateral drawer test

  • Position: Supine with test knee at 90° knee flexion & 15° external rotation.
  • Perform a posterior drawer & external rotatory force. Assess for éposterolateral translation.
  • + test: Lateral tibia plateau moves posteriorly with a stable medial plateau.

External rotation recurvatum test

  • Supine position: Hold foot and externally rotate at 0° knee extension.
  • Support proximally to the knee joint with other hand and hyperextend the knee.
  • Compare to contralateral side. Hyperextension indicative of PCL & PLC instability.

Reverse pivot test

  • Supine position with starting knee position of 90°: Extend and at 80° knee flexion apply a valgus & externally rotation force then extend knee while applying this force.
  • Compare with contralateral side
  • Positive test: tibia reduces from subluxation in flexion when the Iliotiobial is a predominant knee flexor and then becomes a predominant extensor moment to the knee at end range of knee extension.
Dial test

Dial test

  • Supine or prone position: Hold foot and externally rotate at 30° & 90° knee flexion. Compare bilaterally.
  • Dial test at 30°: positive if > 30°(average) external rotation
  • Dial test at 90°: positive > 37° (average) With increasing ER at 90° combined PCL & PLC.
Knee Examination

Dial at 30

Knee Examination

Dial at 90

PLC instability

Dial test at 30° demonstrating right knee PLC instability. Repeat test at 90° to exclude associated PCL tear.

Supine dial

Knee Examination

Comparative supine with prone dial to assess for false positive test due to antero-medial knee instability that can also causes and increase in external foot rotation. During supine dial test confirm no antero-medial instability.

Knee Examination

External rotation recurvatum test

    • Supine position: Hold foot and externally rotate at 0° knee extension.
    • Support proximally to the knee joint with the other hand and hyperextend the knee.

 

Reverse pivot test

  • Supine position with starting knee position of 90°: Extend and at 80° knee flexion apply a valgus & externally rotation force then extend knee while applying this force.
  • Compare with contralateral side
  • Positive test: tibia reduces from subluxation in flexion when the Iliotiobial is a predominant knee flexor and then becomes a predominant extensor moment to the knee at end range of knee extension.

 

Dislocated Knee

Exclude vascular injury & assess common peroneal nerve function.

ACL and PCL tears

Combination of ACL & PCL ligament injury.

Multi-ligament instability

https://www.assic-health.com/wp-content/uploads/2018/05/combined.mp4

Combined ACL & PCL instability

https://www.assic-health.com/wp-content/uploads/2018/05/Media4.m4v

5 months post surgery stable knee

Meniscus

Various meniscus tests are available and range from palpation to loading the meniscus with direct axial compression by the examiner or by the utilization of compression – Using the patient’s own body weight to generate a force in either standing or walking with varying degrees of knee flexion. The principles are based on loading the meniscus while testing in varying degrees of knee flexion ± rotational movements by a force transmission. A few common tests are highlighted.

Knee Examination

Commonly used meniscus tests:

  • Palpate joint line tenderness
  • McMurray test
  • Thessaly test
  • Apley test

Meniscus tests

The Apley test

  • Position: patient in a prone position with the tested knee at 90° of flexion. The examiner holds the patient heel & applies an axial compression load while rotating the tibia on the femur.
  • Positive test: + pain on axial compression

Thessaly test

  • Position: Patient stands on a single leg to be tested & then flexes the knee to 20°. The clinician supports the patient by holding their outstretched hands. The patient then rotates their knee and body 3 times, both internally and externally while in a position of 20° of knee flexion.
  • Positive test: + joint line pain ± click.

McMurray test

  • Position: Patient is supine. The examiner holds the patient’s foot and flexes the patient’s hip and knee and palpating the knee joint line for a pop or click as the tibia is internally and externally rotated while extending the knee.
  • Positive test: + click or pop
https://www.assic-health.com/wp-content/uploads/2018/05/Media1.m4v
Meniscus tests

Duck walking

  • Deep knee flexion predominantly loads the posterior horn of the meniscus and loading the meniscus in this position is used to test for posterior horn tears: Duck walking i.e. loading the meniscus in deep flexion while using the patient’s body weight as a force may be used to test for posterior horn tears.
  • Positive test: + pain
Patellar

Patellar

Examination: focus on regional & global assessment

  • Examine Hip anteversion, tibia rotation & foot position profile
  • Observation: J sign
  • Palpation
  • Assess lateral translation
  • Apprehension test

Patellar: Q angle

Assess regional & global alignment

Q Angle

Factors affecting patella tracking

Q Angle

Examine hip:
Assess hip rotation and assess femoral neck version

Knee Examination

Hip range of motion: Internal & External rotation

Assess femoral neck anteversion
Modified Craigs test

Knee Examination

Traditional femoral neck anteversion test (Craig test) is done in a prone position with hip in neutral position with knee flexed to 90°. Palpate the greater trochanter and rotate femur internally while palpating the greater trochanter. When greater trochanter lies at most lateral aspect the angle measurement is taken from the angle of rotation to neutral reference point.

Examine hip:
Assess hip rotation and assess femoral neck version

Patellar

Hip range of motion: Internal & External rotation

Assess femoral neck anteversion
Modified Craigs test

Low Arch Foot

Low arch foot with genu valgus increases Q angle with increased risk of Patellar femoral dysfunction

Knee extensor mechanism

Muscle and tendon attachments
Knee Examination

Straight leg raise

If extensor mechanism absent assess patellar height position & palpate for any structural defect.

Knee extensor mechanism

Intact extensor mechanism allows knee Range of motion (ROM). Disruption thereof causes the inability to extend the knee

+ J sign

Palpation

Palpation
Assess lateral translation & tilt



Knee Examination

Assess lateral translation & also quantify the degree of lateral translation.

Increased lateral translation after recurrent Patellar dislocation.



Patellar dislocation: Torn MPFL with apprehension on stability testing.

Patellar Apprehension Test

Knee Examination

Apply valgus force to patellar & flex from full extension. Positive test: Patient apprehend movement due to pain & patellar subluxation.

References

  • Harrison BK, Abell BE, Gibson TW. The Thessaly test for the detection of meniscal tears: validation of a new physical examination technique for primary care medicine. Clin J Sport Med. 2009 Jan;19(1):9-12.

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