THE KNEE EXAMINATION

Anatomy of Knee
O 3 Bones:

- Tibia, Femur,
Patella
O 3 Compartments

- Medial, Lateral,
Patellofemoral
O 4 Ligaments

- MCL, LCL, ACL, PCL

O 2 Meniscus
O Articular Cartilage

Anatomy & Physiology of Knee

Medial
Collateral
Ligament
(MCL)

known as the Tibial Collateral

Ligament, provides stability to
the inner (medial) aspect of the
knee.

Lateral
Collateral
Ligament
(LCL)

known as the Fibular Collateral

Ligament, provides stability to
the outer (lateral) aspect of the
knee

Anterior
Cruciate
Ligament
(ACL)

in the center of the knee, limits

rotation and forward movement
of the Tibia

Posterior
Cruciate
Ligament
(PCL)

also in the center of the knee,

and like the ACL secondarily
limits rotation, while primarily
limits backward movement of
the Tibia.

CHIEF
Pain

Swelling
COMPLAINS

Stiffness

Mechanical disorder (locking, giving way, )

Deformity

Limp

Position of the Examination

Standing

Sitting

Supine

Prone

INSPECTION-SIGNS WITH THE PATIENT UPRIGHT

O Deformity (valgus or varus or

hyperextension)

Examination standing : Look at the general shape and posture, rst from in
front and then from behind. Look for swelling of the joint or wasting of the
thigh muscles.

INSPECTION-SIGNS WITH THE PATIENT LYING

SUPINE
O Examination with the patient supine

Wasting of the quadriceps occurs rapidly

after any internal derangement of the
knee.
O The girth is measured at the same level

in both limbs, about a hands breadth

above the patella.

PALPATION

Tests for Intra-articular Fluid

Cross Fluctuation :
O This test is applicable only if there is

a large effusion. The left hand

compresses

and

empties

the

suprapatellar pouch while the right

hand straddles the front of the joint
below the patella
O

By Squeezing with each hand

alternately,

uid

impulse

transmitted across the joint.

Is

The Patellar Tap :

O

Again the suprapatellar pouch is

compressed with the left hand to
squeeze any uid from The pouch
into the joint.

O With the other hand the Patella is

then tapped sharply backwards onto

the Femoral condyles.

The Bulge Test :

O Compress or stroked medial sideof

knee to proximally to move the fluid

away.
O Positive Bulge appear at the medial

of patella.

The Juxta-Patellar Hollow Test :

O Normally, when the knee is exed, a

hollow appears lateral to the patellar

ligament and disappears with further
exion;
O If there Is Excess uid, the hollow

lls and disappears at a lesser Angle

of exion. Compare this in The two
knees.

SPECIAL TESTS

Special Test - ACL Injury

Lachman Test :
O Knee flexed to 20-30 degrees
O Anterior force on tibia.
O Laxicty indicates ACL injury.

Anterior drawer :
O Knee flexed to 90 degrees
O Anterior force on tibia.
O Laxity/anterior translation : ACL

Injury.

Special Test - ACL Injury

Pivot shift:
O Supine, extend knee,foot to flex hip

45, IR, Valgus force on proximal

tibia, then flex knee
O Clunk with knee flexion indicates

ACL injury.

Special Test - PCL Injury

Posterior Drawer Test
O Knee flexed to 90 degrees
O Posterior force on tibia.
O Posterior translation : PCL Injury

Posterior Sag Sign :

O Supine, hip 45, knee 90, view

lateraly
O Posterior translation of tibia (on

femur ) indicates PCL Injury.

Meniscal Injury : McMurray test

Test Medial and Lateral
meniscus separately.
O MedialFlex/varus/ER

knee,then extend
O LateralFlex/valgus/IR

knee,then extend
O Positive : pop or pain

Meniscal Injury :
Apleys Compression
O Prone,

knee

90,

compress and rotate.

O Positive : pop or

pain

Special Test - MCL Injury

O Valgus Stress Testing :
O Knee flexed to 30 degrees
O Lateral force applied to knee
O Look and feel for translation

and endpoint
O Compare to uninjured side
O May repeat with knee in full

extension

Special Test - LCL Injury

O Varus Stress Testing :
O Same test as

valgus stress
testing
O Except applying

medial force to
knee at 30

Special Test - Meniscal Injury

O Thessaly Test :
O Patient stands on affected

leg
O Knee bent at 20
O Examiner holds pts hands

and

rotates

pt

to

both

sides.
O Meniscal grind
O Positive test: pain, painful

click.

Radiologic
Imaging

Knee X-Ray
Anterior-Posterior (AP)
and

Lateral.

context

of

In

the

trauma

the

Lateral view is acquired

with

the

supine
horizontal

patient
and

lying

with

X-ray

beam.

This allows effusions to

be

visualised

in

suprapatellar pouch.

the

Knee X-Ray : Lateral

SUNRISE VIEW
It looks like a sun floating above
the

horizon.

This

view

demonstrates the patellofemoral

joint space.
When

looking

at

the

normal

Sunrise view:
O There is space between the

patella

and

the

femur

(patellofemoral joint space).

O The bones are more opaque

than surrounding soft tissue.

O The patella is projected free of

superimposition.

CT- Scan
O Useful for showing patello-femoral

congruence at various angles of flexion

MRI
O More

helpful

in

identifying

the

knee

disorder so we can make an early diagnosis