Knee Evaluation

Amy Miller, M.D.

University of Michigan
Department of Family Medicine
 Relationships with Industry
UMMS policy requires that faculty members
disclose to students and trainees their industry
relationships in order to promote an ethical &
transparent culture in research, clinical care, and
teaching.
I have no outside relationships with industry.
Currently, I do not serve as the PI on any
industry supported research projects.
 Anatomy
 Bony Anatomy
 Ligaments
 Cartilage
 Musculature
 Other Soft Tissue
 Patient History.
 Nature of symptoms  Age
 Location  Occupation or
 Timing/Duration recreational activities
 Quality and Quantity  Clicking or popping
 Trauma or preceding  Locking or catching
event  Giving Way
 Exacerbating or  Swelling
relieving factors
 Past History
 Physical Exam
 Observation
 Palpation
 Range of Motion
 Strength Testing
 Special Testing
 Observation
Anterior view standing
 Genu valgum/varum, patella position, foot architecture
Lateral view standing
 Genu recurvatum, patella alta/baja
Posterior view standing
 Genu valgum/varum, foot architecture
Anterior and lateral views sitting
 Patella position/tracking, tibial torsion, osgood schlatter’s
changes
Gait
 General changes, motion of patella, foot architecture
 Palpation
Anterior with knee extended Anterior with knee flexed
 Swelling or effusion  Joint lines
 Patella, patellar tendon,  Femoral condyles
plica  Tibial Plateau
 Quadriceps musculature
and tendon Posterior with flexion
 MCL/LCL
 Hamstrings
 Pes Anserine
 Gastrocnemius
 IT Band
 Arcuate-popliteus
 Baker’s Cyst
 Range of Motion
 Flexion – 135 -140 degrees
 Extension – 0 degrees
 Medial rotation of tibia on femur – 20-30
degrees
 Lateral rotation of tibia on femur – 30-40
degrees
Strength Testing (5 point scale)
Flexion
 Hamstring L5-S2
 Gracilis, sartorius L2-3
 Popliteus L4-S1
 Gastrocnemius S1-2
 Tensor Fascia Latae L4-5
 Plantaris S1-2
Extension
 Quadriceps L2-4
 Tensor Fasciae Latae L4-5
 Collateral Ligaments
MCL
 Valgus stress at 0
and 30 degrees

LCL
 Varus stress at 0 and
30 degrees
 ACL
 Lachman
 Anterior Drawer
 Pivot Shift
 PCL
 Posterior Sag
 Posterior Drawer
 Godfrey (gravity) Test
 Meniscus
 McMurray’s
 Apley’s
 Bounce Home
 Patellofemoral
 Clarke’s sign/patellar
inhibition/grind
 Active patellar
grind/crepitus
 Apprehension/hyper
mobility
 Others
 Q angle
 Leg Length
 Ober’s Test
 Neurovascular
 Dermatomes
 Distal pulses for
integrity of arterial
supply mainly with
concern of dislocation
 Palpation of cord or
vascular abnormality
with possible DVT
 Diagnostic Imaging
X-rays
 Ottawa Rules
 AP
 Lateral
 Skyline
 Notch
 Diagnostic Imaging
 CT – More detailed bony evaluation
 MRI – More detailed bony evaluation and
good evaluation of soft tissue structures
 Ultrasound – Good, detailed evaluation of
more superficial soft tissue structures