KNEE SPECIAL TEST

TEST FOR LIGAMENTS

Test for One Plane Medial Instability (THALIA)

•Abduction/Valgus Stress Test

Position: Supine
Procedure:
1. Pt's ankle is slightly laterally rotated. Examiner stabilizes the pt's ankle then apply valgus stress at knee
(Push knee medially).
2. Flex pt's knee to 20*-30* so that it is unlocked, then apply valgus stress.

•Hughston's Valgus Stress Test (3rd way)

Position: Supine
1. Examiner faces pt's foot, placing the body against the thigh to stabilize upper leg, other hand
grasps big toe and apply valgus stress allowing the tibia to move.
(+)tibia moves away from femur
INJURED STRUCTURES EXTENDED
1.MCL 5. PCL
2. Posterior Oblique Ligament 6. Medial Quadriceps Expansion
3. Posteromedial capsule 7. Semimem mm
4. ACL
20*-30* FLEXED
1. MCL 3. PCL
2. Posterior Oblique Ligament 4. Posteromedial capsule
Test for One Plane Lateral Instability

•Abduction/ Varus Stress Test

Position: Supine
Procedure:
1. Pt's ankle is slightly laterally rotated. Examiner stabilizes the pt's ankle then apply varus stress at knee
(Push knee laterally).
2. Flex pt's knee to 20*-30* so that it is unlocked, then apply varus stress.

•Hughston's Varus Stress Test (3rd way)

Position: Supine
3. Examiner faces pt's foot, placing the body against the thigh to stabilize upper leg, other hand
grasps big toe and apply varus stress allowing the tibia to move.
(+)tibia moves away from femur
INJURED STRUCTURES EXTENDED
1. LCL 5. PCL
2. Posteromedial capsule 6. ACL
3. Arcuate popliteus complex 7. Lateral gastrocnemius mm
4. Biceps femoris tendon 8. ITB
20*-30* FLEXED
1. LCL
2. Posteromedial capsule 4. ITB
3. Arcuate popliteus complex 5. Biceps femoris tendon

Test for One Plane Anterior Instability (RALPH)

ACTIVE DRAWER TEST

-px pos for normal drawer test supine flexed one leg
-examiner holds foot of the px
 –px asked to straighten the leg
-then examiner prevents the movement If ACL & PCL is torn
-anterior contour of knee changes If PCL is torb
-posterior sag is evident If there is no posterior sag and tibia shifts toward injured side
(+) for ACL disruption
Second part -ask px to contract hamstrings so tibial plateau moves posteriorly
-this part accentuates posterior sag for Post. Cruciate Insufficiency if present, and ensures max. movt for
Ant Cruciate Insufficiency quads contraction is tried on second time.

DRAWER SIGN
-px lies supine -px knee flexed 90° hip flexed 45°
-examiner sits on the forefoot of the px and in neutral pos.
-examiner places hand around tibia and is drawn forward to femur Normal amt. of mov.t (6mm)
(+) if it moves more than (6mm)
Structures may be injured:
ACL (esp antermodeial bundle)
POSTEROLATERAL CAPSULE POSTEROMEDIAL CAPSULE MCL (deep fibers)
ILIOTIBIAL BAND
POSTERIOR OBLIQUE LIGAMENT
ARCUATE POPLITEUS COMPLEX
-if only acl is torn (-) because other structures limits mov.t
-examiner also ensures pcl is not injured or torn as it may allow tibia to drop or slide back (false
negative)
Modification (90°-90° anterior drawer) –
px le supine
-examiner flex hip and knee 90° supports leg by trunk and forearm
-examiner places hand around tibia, Applies sufficient force to slowly lift buttock –
there is audible snap or palpable jerk (finochietto jumping sign)
-meniscus lesion accompanying ACL torn –
after this mov.t tibia is pushed back on femur (posterior drawer)
(+) posterior sag
Ff are injured: POST CRUCIATE LIG, ARCUATE POPLITEUS COMPLE, POST OBLIQUE LIG, ANT
CRUCIATE LIG
-if APC is still intact examiner forcefully laterally rotates tibia -excessive motion
(+) posterolateral instability Called (arcuate spin test)
Mod (sitting ant drawer test)
-px sitting legs hanging freely
-examiner places hand around tibia and slowly draws tibia forward and back -to test both ant and post
drawer –
using thumb examiner palpates tibial plateau mov.t relative to femur
-check for rotational deformities

LACHMAN TEST (RITCHIE, TRILLAT, LACHMAN-TRILLAT) –

px lies supine with involved leg beside examiner –
examiner holds px knee between full extension and 30° of flexion
-px femur is stabilized by one hand and another hand will placed to prox aspect of tibia -to achieve besy
results it should be slightly laterally rotated -applying translation force on tibia
(+) mushy or soft end feel and disappearance of infrapatellar tendon slope (False negative) may occur if
femur is not properly stabilized Indicates injury to ff: ACL POL APL
MOD 1 -sitting leg over edge of examining table -examiner sits facing px supports foot so px knee is flexed
30° -stabilize thigh and pulls tibia forward -abnormal forward motion considered (+)
MOD 2 (Examiners with small hands) -px lies supine px knee is resting on examiners knee -stabilize thigh
and other hand applies anterior stress
MOD 3 (DROPLEG LACHMAN) -px lies supine leg slightly abducted -knee flexed 25° -foot is held between
examiners knee -stabilize thigh and other hand on tibia applying translation force -there is greater laxity
when doing this test
MOD 4 -px supine -stabilize foot between thorax and arm -both hands placed around tibia knee flexed to
20°-30° -anterior drawer performed -not sufficient to show good (+) sign
MOD 5 -px supine -examiner stands beside leg of px with eyes leveled with knee -grasp femur and tibia
on the other hand -pulls tibia forward abnormal motion is noted
MOD 6 (PRONE LACHMAN TEST) -px prone -examiner stabilize foot between thorax and arm -places one
hand on tibia -gravity assisted anterior mov.t End feel is difficult to determine
MOD 7 ACTIVE (NO TOUCH LACHMAN TEST) -px lies supine -knee to be tested placed over examiners
forearm so the knee is flexed 30° -ask px to actively extend knee examiner watches ant. displacement of
tibia
MOD 8 (QUADRICEPS TEST) -same procedure with mod 7 -but foot is held on table to increase pull of
quads Examiner must be certain there is no posterior sag
GRADING STRESS RADIOGRAPH
GRADE 1- 3-6 mm ant. movt
GRADE 2- 6-9 mm
GRADE 3- 10-16 mm
GRADE 4- 16-20 mm
Test for One Plane Posterior Instability (LYNDON)
Godfrey test( gravity sign)
Px: lies supine position

Pt: the examiner will hold both legs while flexing the px`s hip and knee 90°

(+): if there is posterior instability, a posterior sag of the tibia is seen

Posterior sag sign( gravity drawer test)

Px: the px lies supine w/ the hip flex 45° and kne flex 90°

(+): tibia will "drop back" or sag back, on the femur because of gravity if the posterior cruciate ligament
is torn Posterior tibial displacement is more noticable if the knee is flexed to 90 to 110°

Reverse lachman test

Px: the patient lies prone with the kneee flex to 30 degrees

PT: the examjner will grasp the tibia and the other hand will stabilize the femur then will instruct the pt
to relax the hamstrings muscle, then the examiner will pull the tibia upward(posteriorly)

(+) the examiner will examine the quality of end feel Normally its soft

Indication: posterior cruciate ligament instability

Test for Anteromedial Rotatory Instability (KATHLENE)

Dejour Test
Pt. Pos: lies supine
Procedure: PTs upper hand holds the leg with one arm against the body & the lower hand under the calf
to lift the tibia while applying valgus stress. Using the upper hand pushes the femur downward.
Indication:
Extension - action causes anteromedial subluxation in the pathological knee.
If flexed the knee - the tibial plateau reduces suddenly
If jolt is painful - medial meniscus is injured
If it's not painful - posteromedial corner is injured

Slocum Tets
Pt. Pos: supine lying
Procedure: Pts knee flexed 80 - 90° & hip flexed 45°
1st Part: Foot placed 30° medial rotation & draws tibia forward
(+) : movement occurs on lateral side & indicates ALRI
2nd Part: Foot placed 15° lateral rotation & draws tibia forward
(+) : movement occurs on medial side & indicates AMRI

Test for Anterolateral Rotatory Instability

Active Pivot Shift Test

Pt. Pos: Sitting
Procedure: Foot on the floor on neutral rotation & knee flexed 80 - 90° Ask the pt. to isometrically
contract the quadriceps
(+) : indicated by anterolateral subluxation of lateral tibial plateau & is indicative of anterolateral
instability
Crossover Test of Arnold
Pt. Pos:Standing
Pt. asked to cross the unaffected leg in front of affected leg. Examiner carefully steps on the pts affected
foot to stabilize it & rotate the upper trunk away from the injured leg approx. 90° Then pt contracts the
quadriceps mms

Flexion Extension Valgus Test (JACKIELYN)

patient position: supine lying
Procedure: holds patient slide, examiner pulsates joint line with the thumb and fingers of both hands .
valgus stress and axial compression or applied while knee is flex and extend significance
: if anterior cruciate ligament is torn, examiner feel reduction and subluxation

Jerk Test of hughston

Patient position: supine
Procedure: hip flex 45 degrees, test knee is flexed to 90 degrees. leg is then extended while maintaining
medial rotation and valgus stress
Significance: at approximately 20 to 30 degrees flexion, tibia shift forward posting subluxation of lateral
tibial plateau with a jerk, indicates anterolateral rotatory instability

Lateral Pivot Shift Maneuver or Test of Maclntosh

patient position: supine, hip bone flex and abducted 30°°, relax slight medial rotation for about 20°
procedure: hold patient foot with one hand, other hand place at the knee, holding the leg in medial
rotation when then apply valgus stress maintaining medial rotation while extending and flexing the knee
significance: positive test if click occurred during test,
indicate meniscus pathology, 30 degrees to 40 degrees of flexion tibia reduces or jogs backward.

Lemaire's Jolt test

Patient position: side lying , left leg is in the uppermost
Procedure: patient must be relax with one hand, examiner medially rotates tibia, grasping foot and
medial rotating it with knee extension. back of other hand pushes lightly against the biceps tendon and
the head of fibula while hand one foot flexes and extended the knee
significance: 15 to 20 degrees, jolt occurs with displacement of tibia
indicates anterolateral instability.

LOOSE TEST: (IRIS)

Pt: supine, relaxed Ex: Holds pt ankle and foot so leg is ER
Procedure:
1.Knee flexed 30 deg
2. Other hand: fingers lie over patella and thumb on the fibular head
3. Apply valgus force to the knee
4. Extend pt's knee and apply forwarf pressure behind the fibular head with the thumb
5. Allow ankle and foot to medial rotate
(+): clunk before extension
Sig: Injury to ACL, posterolat capsule, APL, LCL, ITB
MARTENS TEST:
Pt: supine EX: hold pt's anke between trunk and arms around tibia
Procedure:
1. Grips pt's leg distal to the knee joint with one hand
2. Push femur posteriorly with other hand
3. Valgus stress is aoolied to the knee as the knee is flexed
(+): Tibia reduces
Sig: ALRI
NAKAJIMA TEST:
Pt: supine EX: stand on the side of test leg
Procedure:
1. Pt's foot held in one hanx, IR the tibia, knee flexed 90 deg
2. Other hand: on lateral femoral condyle with the thumb behind head of fibula pushing it forward
3. Slowly extend the knee, pushing head of fibula forward
(+): subluxation
Sig: ALRI
NOYES FLEXION-ROTATION DRAWER TEST:
Pt: supine EX: holds pt's ankle bet trunk and with hand around tibia
Procedure:
1. Examiner flexes pt's knee to 20-30 deg maintaing tibia in nuetral rotation
2. Tibia is pushed posteriorly
3. If released, femur is allowed to rotate ER and IR
(+): reduces subluxation of tibia
Sig: ALRI
SLOCUM ANTEROLATERAL INSTABILITY TEST:
Pt: side lying position apprix 30 deg from supine Bottom leg is the uninvolved leg
Procedure: 1. Uninvolved leg is flexed to add stability
2. Foot of involved leg: rests and stabilized on the ecamining table, with foot in IR and knee in
extension and valgus 3. Apply valgus stress to tbe knee while flexing the knee (+): Subluxation
reduces at 25 deg to 45 deg of flexion

Test for Posteromedial Rotatory Instability (WANDA)

Hughston Posteromedial Drawer sign

Pos.: supine/sitting
Procedure: flex knee 90° hip 45° ,slightly medial rotate foot and sit to stabilize, push tibia posteriorly
+: excessive movt. of tibia in medial aspect
Sig: posteromedial rotatory instability
MOD. Hughston posterolateral drawer sign
Pos.: supine/sitting
Procedure: flex knee 90° hip 45° ,slightly lateral rotate foot and sit to stabilize, push tibia posteriorly
+: excessive movt. of tibia in lateral aspect
Sig: posterolateral rotatory instability

Posteromedial Pivot Shift Test

Pos.: supine
Pro: flex knee 45° apply varus, LH apply compression and medial rotate
+ posterior subluxation on medial tibial platue
Pro: extend knee in 20-40°
+: tibial shift in reduced position
Sig: posteromedial rotatory instability
Test for Posterolateral Rotatory Instability
Active Posterolateral Drawer sign
Pos: sitting with foot flat on the floor
Pro: ask pt to contruct hamstring( biceps femoris)
+: post. subluxation of lateral tibial platue
Sig: posterolateral instability.

Dynamic Posterior Shift test

Post: supine
Pro: flex hip and knee 90° UH in ant. thigh LH ankle. Extend knee
+: tibia reduces ant. with clunck *
if painful before extension reduce hip flexion but make sure hamstring is tight
Sig: posterolateral instability

External Rotation Recurvatum Test (KHYLA)

1st Method:
Px: Supine
Procedure: Grasp the big toe of each foot and lifts both feet off the examining table
significance: observe the tibial tuberosities.

2nd method:
Px: Supine
Procedure: Examiner hold the patient's heel or foot and flexes knee 30-40° and then slowly extends it.
(+) hyperextension and lateral rotation occuring in injured limb compared to uninjured

Jakob (Reverse Pivot Shift Maneuver)

Method 1
Px: Standing
Procedure: Pt. stands and leans against wall with uninjured side adjacent to wall.
Examiner hands are placed ABOVE and BELOW the knee; Valgus stress while flexion is initiated.
(+) jerk or giving way
Injury to LCL, arcuate popliteus, lateral capsule

Method 2
Px: Supine
Procedure:
Lift legs, support it with your pelvis, support lateral side of calf. Knee flexed 70-80° foot laterally rotated,
then knee is taken into extension.
(+) Reduction of subluxation

Loomer's Posterolateral Rotatory Instability

Px: Supine
Procedure: Flexes hip and knee 90° then grasp feet and maximally laterally rotated both tibias.
(+) Injured tibia has excessive lateral rotation

Standing Apprehension
Px: Standing
Procedure: One leg stance then examiner push anterolateral part of Lateral femoral condyle anteriorly
and medially. The patient is asked to slightly flex the knee while examiner pushed with thumb.
(+) Condylar movement & giving way

TEST FOR MENISCAL INJURY

ANDERSONS MEDIAL-LATERAL GRIND TEST (BRAYN)

pt: supine, test leg between trunk and upper arm

procedure:
index and thumb of opposite hand placed over the ant. jt. line
valgus stress is applied as knee passively flexed to 45 degrees
virus stress is applied as knee is passively extended producing circular motion
motion is repeated while increasing virus ang valgus stress
(+)sign: grinding in the jt. line
Significance: meniscus pathology
(+)sign: pivot shift
Significance: ACL tear

•APLEY'S TEST

pt: prone, knee flexed to 90 degrees

Procedure:
thigh is anchored to the examining table with examiners knee
distract tibia then medially and laterally rotate it (note for the restriction, excessive movement,
discomfort)
compress tibia then medially and laterally rotate
(+)sign: ROTATION+DISTRACTION is painful/increased in rotation
Significance: ligamentous lesion
(+)ROTATION+COMPRESSION is more painful/ decreased in rotation
Significance: meniscus injury

•BOHLER'S SIGN
pt: supine
Procedure: apply valgus and virus stress to the •"BOUNCE HOME" TEST
knee pt: supine
(+)sign: pain on the opposite jt. line Procedure:
Significance: meniscus pathology heel of the Pt. is cupped
knee is fully flexed
 then passively extended
(+)sign: extension is not complete/springy block
Significance: block/torn in meniscus

•BRAGARD'S SIGN (+)sign: pain/tenderness in medial jt. line

pt: supine Significance: medial meniscus pathology
Procedure: then medially rotate tibia and flex knee
examiner flexes knee ang laterally rotates tibia (+)sign: decrease pain and tenderness
extend knee Significance: medial meniscus pathology

CABOT’S POPLITEAL SIGN (KAREN)

Pt pos: Supine, leg figure four position
Procedure: 1. Palpate jt line with thumb and forefinger
2. One hand proximal to the ankle
3. Pt ask to straighten knee while examiner resist the movement
(+): pain on the jt
Sig: meniscus lesion

CHILDRESS’ SIGN
Pt pos: squats
Procedure: 1. Pt perform a “duck waddle”
(+): pain, snapping or click
Sig: posterior horn lesion of meniscus
DYNAMIC KNEE TEST
Pt pos: Supine, hip flexed, abd 60, lateral rotate 45, knee 90 flex, so lateral border rest in the examining
table
Procedure: palpate lateral jt line, adduct hip
(+): increased pain, sharp pain at end of add
Sig:lateral meniscus tear
EGE’S TEST
Pt pos: Stands with knees in extension and feet 30-40 cm away from each other
1. TEST FOR MEDIAL MENISCUS
Procedure: -
(1.)pt laterally rotate each tibia maximally and squats causing distance between knees and
lateral rotation to increase
(2.) pt the. Stands slowly leaving the feet laterally rotated
2. TEST FOR LATERAL MENISCUS
Procedure: both tibias are medially rotated maximally while pt squats and stands up
1(+): pain or click in early knee flexion Sig: anterior tear
2(+): pain or click in more flexion Sig: posterior horn tears
Kromer’s Sign : (CHENG)
Pt. is in supine position
Procedure : apply a valgus and varus stress while the knee is flexed and extended.
(+) test is indicated with the same pain on the opposite joint
•McMurray Test
Pt. is in supine position
 Procedure: flex the knee of the patient with the heel on the buttocks. To test for the lateral meniscus,
medially rotate the tibia and extend the knee of the patient. To test for the medial meniscus,laterally
rotate the tibia and extend the knee of the pt.
(+) test if there is a snap, click and pain either on the lateral or medial meniscus
•Modified Helfet Test
pt. is in sitting position
Procedure: . Normally the tibial tuberosity is in line with the midline of the patella with the knee flexed at
90deg, however, if the patient’s knee is extended, the tibial tubercle is in line with the lateral border of
the patella
(+) . If this change does not occur with the change of movement,
SIG: rotation is blocked, or a possible cruciate injury, or the Quadriceps muscles have insufficient
strength to screwhome the knee.
•O’Donoghue Test
Procedure: flex the knee of the pt. into 90deg, medially and laterally rotate the tibia twice. I will fully
flexes the knee again, and rotate it again in both ways.
(+) test is indicated if there is increased pain on rotation on either or in both positions.
It indicates that there is capsular irritation or meniscus tear

PASSLER ROTATIONA GRIND TEST (FLORIE)

px: sitting, with knee extended and the ankkle is held between examiner's legs
PT: examiner places both thumbs over medial joint line, medially and rotate the tibia while the knee is
rotated through various flexion angles.
(+) pain
Sig: meniscus lesion

PAYR'S TEST
px: lies supine with tested leg in figure - four position
(+) pain on medial joint line
Sig: meniscus lesion
STEINMAN'S TENDERNESS DISPLACEMENT TEST
px: sitting, supine ( wala na indicate sa book)
Procedure: pt. Actively latetal rotate and medial rotate the knee
(+) • medil pain- lateral rotation • latera pain - medial rotation
Sig: meniscus tear
TEST FOR RETREATING OR RETRACTING MENISCUS
px: sits on the edge of table or lies supine
PT: flex knee to 90°, place one hand over the joint line of patients knee ( babaw tuhod), holds ankle and
medially and laterally rotate the leg and foot. Normally, there is an appearing and disappearing of
meniscus
(+) if meniscus did not appear
Sig: meniscus torn
THESALY TEST
px: standing on one leg ( unaffected s tested first)
PT: holds px arm for support and instruct the pt. to bend the knee 5° and rotates femur and tibia medially
and laterally for several times, *Repeat same procedure but in 20° knee flexion.
(+) if there is discomfort on medila and lateral rotation
Sig: meniscus tear.

TEST FOR PLICA LESIONS

Hughston's Plica Test –( BEA)
[ ] Position: Supine –
 [x] Procedure: -
[ ] Examiner flexes the knee & medially rotates the tibia with one arm & hand while pressing the
patella medially with the heel of the other hand. –
[ ] Palpate the medial femoral condyle with the fingers of the same hand –
[ ] Pt's knee is passively flexed and extended while the examiner feels for "popping" of the plica
band under the fingers.
(+): Popping

Mediopatellar Plica Test (Mital- Hayden Test or Medial Plica Shelf Test)
- [ ] Position: supine w/ the affected knee flexed to 30 degrees resting on a support or the
examiner's arm –
[x] Procedure: -Examiner pushes the patella medially w/ the thumb
(+): pain or click caused by pinching between medial femoral condyle and patella

Patellar Bowstring Test –

[ ] Position: Side-lying w/ test leg uppermost –
[x] Procedure: Examiner pushes the patella medially & holds it there and flexes pt's knee and
medially rotates the tibia w/ the other hand –
[ ] The pt's knee is then extended while examiner feels for any sounds -
(+)sound, click

Plica Stutter Test –

[ ] Position: Seated on the edge of the table w/ both knees flexed to 90 degrees –
[ ] Procedure: PT places a finger over one patella to palpate during movement –
[ ] Instruct the pt to slowly extend the knee
(+): patella stutters or jumps somewhere between 60 dgrees to 45 degrees of flexion during an
otherwise smooth movement

TEST FOR SWELLING

Brush / Stroke / Bulge / Wipe Test (PHIL)

A test to assess effusion
Pt- Standing
PT Hand Placement and Procedure
UH- Commences just below the jt line one the medial side of patella, stroking proximally towards Pts Hip,
2-3 times with palm and fingers

LH (Opposite Hand)- downward stroke on the lateral Side

(+) wave of fluid passes on medial distal portion of patella
Indc - Swelling /Effusion

Fluctuation Test
Pt- Supine
PT hand placement/Procedure
UH- over supra-patellar pouch
LH - ant. To joint, fingers beyond margin of patella
Pressing downward alternately
(+) examiners feels fluctuation of fluid
ind - Effusion/swelling

Indentation Test
 Pt- Supine
PT procedure
Passively Flexes the Good knee and Note for indentation which’s present(remains) , on the lat side.
Flex the Injured knee
(+) Indentation Disappears
Ind- Swelling
Note: the greater the swelling the sooner the Indentation disappears, and when you put your thumb and
finger on patellar tendon you may feel the fluctuation of the fluid.

(Patellar Tap Test ) Ballotable Patella

Pt- supine , knee flexed or extended to discomfort
PT - tap the patella,
(+) Floating patella
Note- This test is also called “Dancing patella” sign
Modification
pt supine
PT Hand placement. And Procedure
UH - stroke down on the suprapatellar pouch
LH- lightly place on the both sides of patella,
(+) if the thumb and fingers seperaez
Ind- Swelling

Peripatellar Swelling Test

Pt - supine , knees extended
PT Hand placements/ Procedure
UH - milks the fluid from suprapatellar pouch
LW - palpate the adjacent patellar tendon on the medial side
Note :If there is Wave of fluid passing it is Palpable fluid wave, if less swelling it is visible fluid wave.

Then the LH examiner stroke into the suprapatellar pouch , while UH Squezze or pushes it down,
(+) waves of fluid passes on the hollow parts of patella on the side
Indc – swelling

TEST FOR PATELLOFEMORAL DYSFUNCTION

ACTIVE PATELLAR GRIND TEST ( COLEN)

Patient: Sitting, Knee flexed 90 degrees

Procedure: Hand over patella to feel for crepitus, slowly extend knee
Positive sign: The pain in the ROM tells what part of patella is demonstrating pathology
CLARKE’S SIGN(PATELLAR GRIND TEST)
Patient: Supine
Procedure:
• Web of hand over patella and apply soft downward pressure
• Ask patient to contract quads
• Test in 30-60-90 and full extension
Positive sign: Pain with movement of patella or unable to complete test
ECCENTRIC STEP TEST
Patient: Stands above the stool or 6inch-high step
Procedure: Step down with the injured knee first(testing the good leg first) as slowly as he can
Positive sign: Pain during test
FRUND’S SIGN
Patient: Sitting Position
Procedure: Percuss the patella in various position of knee flexion
Positive sign: Pain, indicates chondromalacia pattelae
LATERAL PULL TEST
Patient: Supine
Procedure: Instruct patient to contract quads Patella goes superior and lateral (normal)
Positive: excessive lateral movement of patella due to excessive lateral pull of quadriceps resulting in
patellofemoral arthralgia
MCCONNEL TEST FOR CHONDROMALACIA PATELLAE
Patient: Sitting with femur laterally rotated
Procedure: Ask patient to contract quads in 120-90-60-30-0 degrees knee flexion If pain appears in any
position while contracting, passively extend the knee, glide the patella medially, bring it back to the
position where pain occurs
Positive: if pain disappears, patient is positive in chondromalacia patellae

PASSIVE PATELLAR TILT TEST (DADA)

postion : supine, knee extended –
PT palpates patella -lift lateral edge of patella away from lateral condyle
(+) angle less than normal
sig : patellofemoral syndrome
STEP UP TEST
position : stand beside a stool one leg on the stool, the other on the floor
PT-ask the pt. to step up (repeat with other leg)
(+) inability to do the test
sig : patellofemoral dysfunction (weak quads)
VASTUS MEDIALIS COORDINATION TEST
position : supine
-PT places fist under the pt's knee –
pt. slowly extends knee without pressing into examiner's fist or lift leg away from fist while achieving full
extension
(+) cannot fully extend knee
sig : patellofemoral dysfunction
WALDRON TEST
position : standing
-PT palpates patella -pt. performs deep knee bends (squats)
(+) pain and crepitus sig : patellofemoral dysfunction
ZOHLER'S SIGN
position : supine, knee extended –
PT pulls the patella distally -ask the pt. to contract quadriceps
(+) pain
sig : patellofemoral dysfunction
OTHERS
Daniel’s Quadriceps Neutral Angle Test (SHEENLEE)
• To diagnose PCL disruption and laxity of the knee
Position: pt supine
Procedure: unaffected leg hip flexion 45 deg and knee flexion 90 deg. Ask pt to extend leg while PT
holding the foot. If there’s tibial dislocation, knee flexion is decreased (posterior tibial displacement) or
increased (anterior tibial displacement). Repeat this motion until there’s no tibial dislocation.
Note: Quadriceps neutral angle position if about 65-90 deg. Testing the affected side in a quadriceps
neutral angle position. Ask the pt contract quadriceps.
If there is an anterior displacement indicates a PCL insufficiency.
Fairbank’s Apprehension test
• for dislocation of patella
Position: pt lies supine, knee flexed 30 deg.
Procedure: slowly and carefully push laterally the patella. If pt feels patella is going to dislocate, pt will
contract the quads mm to bring patella back “into line”
(+): this action indicates positive sign and apprehension

Functional test for Quadriceps Contusion

Position: prone
Procedure: passively flex knee. 90 deg and more, mild contusion. 90 deg and less, moderate to severe.
Patient should not be allowed to bear weight. Heel to buttock distance should not exceed 10 cm (5inch)
or 5 cm (2inch) in women.
(+): if there is a limitation of motion,
 end feel is muscular stretch which indicates quadriceps mm are tight.
 This test may used to test tightness of the quads.

Measurement of muscle bulk (KYUT)

-For anthropometric measurement for effusion and atrophy
* Position: supine
* Procedure: measure for the circumference of the leg and note for the measurement
* Measurement points:
-6 inches below apex of patella
-2 inches above base of patella –
4 inches above base of patella
-6 inches above base of patella
-9 inches above base of patella
* Check the opposite leg , check for asymmetry
Ind: Effusion or atrophy

Moving patellar Apprehension Test –

for lateral patellar Instability
Pt position: supine position w/ thigh on examining table an other is off the table
Procedure:
step 1 - move patella laterally and held while flexing the knee 90 deg then return to full extension.
Step 2- move patella medially and held while flexing knee
(+) shows apprehension in step 1, no apprehension in step 2.
Noble compression test
-for iliotibial band friction syndrome
Pt pos: lies supine
Procedure: flex knee 90 deg and apply lateral femoral epicondyle pressure, While the pressure is
maintained, Passively extend.
(+) approximately 30 deg flexion, and experiences pain on lateral epicondyle.
Q angle or patellofemoral angle
Pt pos: supine
Procedure: draw a lone from the ASIS to midpoint of patella, another from the tibial tubercle until to the
midpoint of patella.(. Normal angle: male : 13 deg Female: 18 deg)
Indication : less than 13 deg - chondromalacia patellae or patella alta, More than 18- chondromalcia
patellae, subluxing patella, increase femoral ante version, genuvalgum, lateral displacement of tibial
tubercle and increased lateral tibial torsion.

Radulescu Sign (JOANNA)

position: prone, knee flexed 90°
procedure: -stabilize pt thigh with one hand and trying to sublux the fibular head anteriorly -(other
hand) medially rotate the tibia
(+) pain, apprehension, subluxation of fibular head
(sig) unstable fibular head

Test for Knee Extension Contracture (Heel Height Difference)

position: prone, thighs supported and legs are relaxed
procedure: -measure the difference in heel height -1 cm of difference approximates 1°, depending on leg
length
(+)accompanying end feel, swelling
(sig.) -joint contracture (tissue stretch) -possibly tight hamstrings (mm stretch) conversion:
Formula: Tangent of Angle Q Heel Height Difference ÷ Lower leg segment length (pt height in cm)=
tangent theta
Tubercle Sulcus Angle ( Q-Angle at 90°)
position: not indicated (pero sitting ah)
procedure:
-draw a vertical line frim the center of patella and to the center of tibial tubercle
-draw a horizontal line through the femoral epicondyle

(+) -normally, the lines are perpendicular

-angles greater than 10° from the perpendicular are considered abnormal

(sig.) Lateral patellar subluxation

(A- angle) - measures the relation of the patella to tibial tubercle

procedure:
-draw a vertical line that divides the patella into two halves
-draw a line from tibial tubercle to the apex of the inferior pole of patella
the resulting angle is A-angle

Wilson Test
position: sitting, legs hanging freely (pt knee should flex 90°)
procedure:
-grasp the pt leg and internally rotate the tibia
-instruct the pt to extend the leg until pain is felt

(+) -pain in the knee about 30° of flexion

-rotating the leg back to its normal position pain disappears

(sig.)
- Internal rotation causes impingement on the OCD lesion of the medial femoral condyle (classic site of
OCD) which causes the pain
- External rotation moves the tibia away from the lesion which relieves the pain