ANATOMY OF KNEE JOINT

&
CLINICAL TESTS

DR. VARUN THOMAS PAUL P

JR,PMR, AIIMS RISHIKESH
The knee joint combines three
articulations
Medial tibiofemoral (M)
Lateral tibiofemoral (L) and
Patellofemoral (P),
which share a common synovial
sheath; anteriorly, this extends a little
to either side (1) of the patella and an
appreciable amount proximal to its
upper pole (2).
1. The lateral ligament (3) extends between the lateral
epicondyle and the head of the fibula.
2. The medial ligament (4), consisting of superficial and deep
parts, is attached above to the medial epicondyle of the
femur, and below to the medial surface of the tibia on either
side of the semimembranosus groove.
3. The anterior cruciate ligament (5) runs between the tibial
plateau anteriorly and the lateral femoral condyle
posteriorly.
4. The posterior cruciate ligament (6) runs between the tibial
plateau posteriorly and the medial femoral condyle
anteriorly.
Both cruciate ligaments lie within the confines of the
intercondylar notch of the femur, thereby avoiding being
trapped between the articular surfaces during movement of
the joint.
5. The posterior ligament (7) is attached to posterior aspects
of the femur and the tibia just outside their articular
margins.
In plan view the medial (m) and lateral (l) menisci are C-shaped; they are triangular in cross-section, and
formed from dense avascular fibrous tissue. Their extremities (horns) (9) are attached to the upper
surface of the tibia on which they lie; the posterior horn of the lateral meniscus has an additional
attachment (10) to the femur, whereas both anterior horns are loosely connected (11). The concave
margin (12) of each meniscus is unattached; the convex margin of the lateral meniscus is anchored to
the tibia by coronary ligaments (13), whereas the corresponding part of the medial meniscus is attached
to the joint capsule (14) and thereby loosely united to both femur and tibia. During extension of the
knee (15) the menisci slide forwards (16) on the tibial plateau and become progressively more
compressed, adapting in shape to the altering contours of the particular portions of the femur and tibia
between which they come to lie. Only the peripheral edges of the menisci have an appreciable blood
supply, so that meniscal tears that involve the more central portions have a poor potential for healing.
Numerous bursae have been described round the knee, but from the practical point of view only a
few are of any real significance.
At the front:
(a) The suprapatellar pouch (SP) or bursa is a normal extension of the synovial compartment of the
knee; it may become prominent as a result of a joint effusion, but treatment is always directed at
the underlying cause rather than this local effect.
(b) A prepatellar bursa (PP) may form between the patella and the overlying skin as a result of
repeated local friction, e.g. from kneeling.
(c) An infrapatellar bursa (IP) may form between the skin and the tibial tubercle or patellar ligament,
again usually as a result of local friction from kneeling. Bursae forming deep to the patellar ligament
(DIP) also occur, but are rather uncommon.
At the back:
Bursal enlargements may be encountered in the popliteal fossa, and these are generally referred to
as Baker’s cysts or enlarged semimembranosus bursae. Some are found to communicate with the
knee joint (sometimes with a valve-like mechanism), and tend to keep pace in terms of distension
with any effusion in the knee.
Others are quite unconnected with the joint. The anatomical explanation is that although the
semimembranosus bursa (SM) itself never communicates with the knee, it is often connected to the
bursa (G) under the medial head of gastrocnemius, which does.
CLINICAL EXAMINATION
INSPECTION
• Attitude
• Alignment
• Swelling
• Effusion
• Skin, scars, sinus
• Patella and Extensor apparatus
PALPATION
ANTERIOR ASPECT
• Temperature and Effusion
• Patella and Extensor Apparatus
• Wilson’s test (Osteochondritis dessicans)
MEDIAL ASPECT
• Joint line tenderness
• Pes anserinus bursa and meniscal cysts
• MCL
LATERAL ASPECT
• LCL and meniscal cysts
• Iliotibial bands and Gerdy’s tubercle
• Ober’s test
• Allis’s test (Galeazzi sign)
POSTERIOR ASPECT
• Confirm and measure flexion deformity
• Baker’s cyst
• Craig’s test (Ryder’s method)
MANIPULATION AND SPECIAL
TESTS
TESTS FOR MENISCI
• Mcmurray test
• Apley’s distraction/ compression test
• Cabot’s maneuver
• Childress’ test
• Passive extension test (Bounce home test)
TESTS FOR STABILITY
• VALGUS AND VARUS LAXITY
o Valgus and Varus stress test
o Cabot’s position
o Henri Dejour “frog position”
• ANTERIOR LAXITY
o Lachman test and Trillat modification
o Anterior drawer test
o Pivot Shift test of McIntosh and Galway
Trace pivot shift “pivot glide of Henri Dejour”
Dejour’s test (pivot shift in extension)
o Hughston’s jerk test
o Losee test
o Flexion rotation drawer test
• POSTERIOR LAXITY
o Godfrey’s sign- posterior tibial sag in 90/90 position
o Muller’s test
o Posterior drawer test and drop back phenomenon
o Quadriceps active drawer test of Daniel
• POSTEROLATERAL INSTABILITY
o External rotation recurvatum test (varus recurvatum test)
o External rotation test
o Reverse pivot shift test
• ANTEROLATERAL ROTATORY INSTABILITY
o Slocum’s test