KNEE EXAMINATION

Inspection  Expose adequately as we should be able to view thigh muscle

up to groin

Anterior
 Skin(scars, swelling)
 Muscle wasting
a. Quadriceps
b. Tibialis anterior
 Bone
a. Alignment
i. Genu varus/ valgus
b. Position of patella with respect to ankle and foot joint
c. Toe deformity
i. Mallet toe, claw toe, hammer toe

Sides
 Flexion
a. Normal: 140˚
b. Hyperflexion cause PCL tear
c. Fixed flexion deformity
i. Inability to fully straighten knee
 Hyperextension deformity (genu recurvatum)
a. Normal: 0˚
 Foot arch
a. Pes planus/ flat foot
b. Pes cavus/ high arch

Posterior
 Skin
a. Scars
b. Swelling
i. Bakers/ popliteal cyst
(1) Fluid filled swelling that cause lump at the back of
knee
ii. Achilles tendon
(1) Swelling/ thickened
 Muscle wasting
a. Calf- Gastrocnemius

Squat

Gait
 Ask patient to walk certain distance, stop turn around and walk
back
a. STANCE PHASE(heel strike>mid-stance>toe off) SWING
PHASE(initial>mid>terminal)
i. Antalgic Gait: shorten stance phase due to pain
ii. High Stepping Gait: foot drop dt common peroneal
injury
iii. Tredelenburg Gait: drop of pelvis when lifting leg
opposite to weak hip abductor(gluteus medius &
minimus) dt superior gluteal nerve injury
 Position of shoulders
a. Drop one side
 Abnormal knee movement
a. Thrust
b. Giving way
 Pelvic tilt n movement if visible
a. Anterior
i. Increase lumbar lordosis & thoracic kyphosis
b. Posterior
Supine
 Ask patient to lie down
 Skin(swelling)
 Muscle wasting
a. Quadriceps
  Parapatellar fossa
i. Fullness possible of effusion

Palpation *Ask about point of MAXIMUM TENDERNESS

 Temperature & crepitus over joints
 Tenderness (knee 90 flex???)
a. Look at patient face!
b. Start from tibial tuberosity and move proximally
c. Feel around patella tendon, patella, medial tibial
plateau(medial meniscus), lateral tibial plateau(lateral
meniscus), medial & lateral femoral condyles, quadriceps
tendon
d. If swelling check consistency: boggy soft or hard

Test for effusion/ Patellar Tap(LARGE VOLUME)

 Compressing supra patellar pouch with one hand
 The other hand pushes patella downward
 POSITIVE: if you can feel patella sink & taps on the
underlying femur, feel bouncing off

Fluid Shift(SMALL VOLUME)

 Use hand to massage any fluid in anteromedial compartment
of knee into suprapatellar pouch
 Stroke lateral side of knee and suprapatellar pouch to push any
fluid back into anteromedial compartment
 Small effusion: bulging along medial parapatellar gutter

Movement *Do active movement and followed by passive straight away

Active
 Flexion & Extension
a. Quantify in degrees: 0-160˚/ -10-140˚
b. Compare range with contralateral limb
c. Feel for crepitus

Passive
 Especially if there’s limitation in active range
 Identify deformities:
a. Fixed flexion deformity
i. Unable to passively extend knee fully
b. Extension lag
i. Able to passively extend a flexed knee

Cruciate Ligament  Flex the knee 90˚ and flex hip

 Tell patient you will need to sit on her foot to stabilise the limb
LATER

Inspection
  Posterior sagging sign
a. Tibia sags downward dt PCL injury
 Medial Tibial Step Off

Drawer Test(Anterior & Posterior)

 Place both thumb over tibial tuberosity
 Using index fingers to relax hamstring behind knee
 Give gentle anterior pull to assess ACL (Anterior drawer test)
 Push tibia posteriorly to assess PCL (Posterior drawer test)

Lachmann Test
*test for ACL laxity, more sensitive
 Flex knee at 30˚
 Resting knee on our flex legs
 Stabilise limb by placing one hand at the distal thigh
 Gently hold leg at calf muscle & pull forward eliciting any
ACL laxity
a. Should feel firm end point

Test For Collateral Collateral Ligament Stress Test

Ligaments  Gently lift leg holding at the distal thigh
 With knee in full extension, give valgus stress to assess laxity
of mcl, varus to assess LCL
 Flex knee to 30 and repeat the test
a. To isolate

Test For Meniscus Injury McMurray Test

 Applies a valgus stress while other hand externally rotate and
extend the knee(medial meniscus)
 Applies varus stress while other hand internally rotate and
extend the knee(lateral meniscus)

Apley Grinding Test

 Patient in prone position & knee 90˚ flex
 Apply axial load then medially & laterally rotate knee.

Joint Line Tenderness