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
