Knee Orthopaedic Tests

Anterior Aspect

Anterior Knee Bursa

Medial & Lateral Aspect

Medial Collateral Ligament

Lateral Aspect

TFL and ITB

Posterior Aspect

Meniscus Instability
The menisci are C-shaped discs of fibrocartilage that are interposed between the condyles of the femur and tibia. Primary function is load transmission or weight bearing.

Secondary function is shock absorption during gait.

Contribute to joint stability and lubrication.

Meniscus Instability
Nerve endings provide proprioceptive feedback for joint position.

A tear or loss of the menisci, either partial or complete, hinders their ability to perform.
A twisting injury to the knee with the foot in weight bearing can injure the menisci. The outer 20% is vascular peripheral injuries may heal.

Meniscus Instability
Clinical Signs and Symptoms
Local medial or lateral joint pain Limited knee range of motion Crepitus upon movement Joint effusion Knee buckling Pain on walking up and down stairs Pain on squatting

Apleys Compression Test

Procedure: Patient prone. Flex leg to 90 degrees. Grasp the patients ankle and apply downward pressure while you internally and externally rotate the leg. Positive Test: Flexing the knee distorts the meniscus. Downward pressure further stresses the meniscus. Pain or crepitus on either side indicates a meniscus injury on that side.

Apleys Compression Test

McMurrays Test
Procedure: Patient supine. Flex leg. Externally rotate the leg as you extend. Internally rotate the leg as you extend. Positive Test: Flexion and extension distort the meniscus. Adding external and internal rotation further distorts the meniscus. A palpable or audible click indicates injury of the meniscus.

McMurrays Test

Ligamentous Instability
The major ligaments of the knee are the anterior and posterior cruciate and the medial and lateral collateral ligaments. Ligament injuries are among the most serious knee disorders.

Usually due to traumatic stress to the knee while bearing weight.

Ligaments

Ligamentous Instability
Valgus stress may sprain or tear the medial collateral ligament.

Varus stress may sprain or tear the lateral collateral ligament.

Both of these stresses with a rotational force may sprain or tear the anterior and/or posterior cruciate ligaments.

Ligamentous Instability
Clinical Signs and Symptoms
Knee pain Limited range of motion Difficulty in weight bearing Joint effusion Knee giving out; chronic unstable knee

Drawer Sign
Procedure: Patient supine. Flex the leg and place the foot on the table. Grasp behind the knee and pull and push on the leg. Hamstring tendons must be relaxed. Positive Test:

Drawer Sign

Drawer Sign

Drawer Sign
More than 5 mm of tibial movement on the femur when leg is pulled - injury or tear to one or more of the following structures is indicated:
Anterior cruciate ligament Posterolateral capsule Posteromedial capsule Medial collateral ligament (more than 1cm movement) Iliotibial band Posterior oblique ligament Arcuate-popliteus complex

Drawer Sign

Drawer Sign
If excessive movement occurs when the leg is pushed, an injury to one or more of the following structures in indicated:
Posterior cruciate ligament Arcuate-popliteus complex Posterior oblique ligament Anterior cruciate ligament

Lachmans Test
Procedure: Patient supine. Knee 30 flexion. Grasp thigh with one hand to stabilize. Grasp tibia with opposite hand and pull forward. Positive Test: Softened feel or anterior translation of the tibia suggests a possible tear of:
Anterior cruciate ligament Posterior oblique ligament

Lachmans Test

Reverse Lachmans Test

Procedure: Patient prone. Flex leg to 30. Stabilize posterior thigh with one hand. Push tibia posterior with the other hand. Positive Test: Posterior pressure on the tibia stresses the posterior cruciate ligament. A soft end feel and posterior translation of the tibia are positive findings.

Reverse Lachmans Test

Apleys Distraction Test

Procedure: Patient prone. Flex leg to 90. Stabilize patients thigh with your knee. Pull on the ankle while internally and externally rotating the leg. Positive Test: Distraction of the knee takes pressure off the meniscus and puts strain on the medial and lateral collateral ligaments (nonspecific).

Apleys Distraction Test

Adduction Stress Test

Procedure: Patient supine. Stabilize medial thigh. Grasp lower leg and push medially.

Positive Test: Excessive movement of the tibia away from the femur indicates a possible tear of:
Tibial collateral ligament Posterior meniscofemoral ligament Posterior medial capsule Anterior cruciate ligament Posterior cruciate ligament

Abduction Stress Test

Procedure: Patient supine. Stabilize lateral thigh. Grasp lower leg and pull it laterally.

Positive Test: Excessive movement of the tibia away from the femur indicates a possible tear of:
Fibular collateral logaments Posterolateral capsule Posterior cruciate ligament Anterior cruciate ligament

Abduction Stress Test

Medial & Lateral Stability Rating Scale

Grade 0 Grade 1+ Grade 2+ Grade 3+ No joint Opening Less than 0.5 cm joint opening 0.5 to 1.0 cm joint opening More than 1cm joint opening

Patellofemoral Dysfunction
The patella protects the anterior aspect of the knee.

It acts as a fulcrum that increases the mechanical advantage of the quadriceps.

The patella lies in the trochlear groove. With normal flexion and extension it tracks smoothly in the groove.

Patellofemoral Dysfunction
Many causes of anterior knee pain involve abnormal tracking of the patella or direct trauma to the patella. Patellofemoral injuries include fractures, dislocations, malalignment syndrome, chondromalacia patellae, and patellofemoral arthritis.

Patellofemoral Dysfunction
Clinical Signs and Symptoms
Anterior knee joint pain Knee joint effusion Popping sensation Joint crepitus Discomfort with stair climbing Knee buckling

Patella Grinding Test

Procedure: Patient supine. Move patella medially and laterally while pressing down.

Positive Test:
Pain under the patella - chondromalacia patellae, retropatellar arthritis, or a chondral fracture. Pain on the patella osteochondritis. Pain over the patella prepatellar bursitis.

Patella Grinding Test

Patella Apprehension Test

Procedure: Patient supine. Manually displace the patella laterally.

Positive Test: A look of apprehension on the patients face and a contraction of the quadriceps muscle indicates a chronic tendency to lateral patella dislocation. Pain is also present with this test.

Patella Apprehension Test

Knee Joint Effusion

Effusion in and around the knee may be caused by trauma, infection, degenerative joint disease, rheumatoid arthritis, gout, or pseudogout. The fluid may contain blood, fat, lymphocytes, and crystals such as urate, pyrophosphate, and oxalate.

Knee Joint Effusion

Clinical Signs and Symptoms
Knee pain on walking Anterior knee inflammation Knee joint warmth to touch

Patella Ballottement Test

Procedure: With one hand, encircle and press down on the superior aspect of the patella. With the other hand, push the patella against the femur with your finger. Positive Test: If fluid is present in the knee, the patella will elevate when pressure is applied. When the patella is pushed down, it will strike the femur with a tap.

Patella Ballottement Test