Knee ExaminationAbdulaziz Al-Ahaideb

MD,FRCSC

Orthopedic physical exam:

Look

Feel

Move

Special tests

Look (always compare)

Alignment ( normal, varus or valgus)

Effusion

Scars

Wasting

Color

P.S. don’t forget to inspect the posterior aspect ( e.g. Baker’s cyst)

Feel

Temperature (compare)

Tenderness ( feel the bony prominences)

Effusion (fluid collection)

* fluctuation

* bulging (milking)

* ballotment (patellar tapping)

Move

Active ( by the patient)

Passive ( by the physician)Feel for crepitus when you take the knee through the range of motion

Special tests

Meniscus

Stability

Meniscal examTenderness in the medial joint line (medial meniscus)

Tenderness in the lateral joint line (lateral meniscus)

McMurrey’s test for medial and lateral meniscus: (VC*)

Stability To test the four ligaments of the knee:

MCL (Medial Collateral Ligament) LCL (Lateral Collateral Ligament) ACL (Anterior Cruciate Ligament) PCL (Posterior Cruciate Ligament)

Stability MCL : Valgus stress test LCL : Varus stress test

Valgus stress test ( for MCL ) (VC*)

ACL examAnterior drawer Anterior drawer testtest:Excessive forward movement of the tibia on the femur

ACL exam

Lachman’s test Lachman’s test (VC*)(VC*):The most sensitive test for ACL rupture

ACL examPivot shift test:Pivot shift test:

When positive, it is painfulWhen positive, it is painful

It needs experience to be able It needs experience to be able to elicit itto elicit it

PCL exam

Posterior drawer test Posterior drawer test

(VC*):(VC*):

excessive backward

movement of the tibia in

relation to the femur.

PCL exam

Sagging sign:Sagging sign: compare both

knees in 90 degrees of flexion.

In the injured knee the proximal tibia is displaced backwards compared to the other

side.

Sagging Sign

Patellar Apprehension test For recurrent patellar

dislocations/subluxations

Thanks