Knee Flashcards
Lachman’s test - ACL
First exclude PCL injury.
Pt in supine.
Bring pt’s leg to 30 degrees flexion.
Fixate femur with outer hand, bring the tibia into slight external rotation, then try to translate the tibia anteriorly.
+’ve test = soft/mushy end feel or anterior translation 3mm more compared to other leg.
Anterior Drawers test - ACL
Pt in supine, hip 45 degree angle, and knee 90 degrees flexion.
Fixate position by sitting on patients foot.
Palpate joint line with thumbs and try to move tibia anteriorly in an explosive movement.
+’ve test = tibia translates anteriorly more than 6mm or soft and mushy end feel.
Pivot shift test - ACL (too many errors in practice)
Pt in supine, both hips abducted to 30 degrees.
Grab the patient’s calcaneous, from the outside to induce tibial internal rotation.
With other hand, give a slight valgus force from the outside at the height of the fibula which subluxes the tibia anteriorly from the femur in extension, in the case of a torn ACL.
Then move pt leg from extension to flexion.
+’ve test = if tibia reduces or jogs backwards at around 30-40 degrees of knee flexion due to the tightening on the iliotibial band
Apley’s test - meniscus
Pt in prone.
Fixate tested leg with your own leg and bring the knee into 90 degrees of flexion.
While you give distraction, perform lateral rotation of the tibia and medial rotation.
- looking for excessive rotation compared to the other side, or discomfort.
Repeat action with compression rather than distraction.
- looking for decreased rotation or discomfort.
If rotation + distraction = more pain or more rotation = lesion is probably ligamentous
If rotation + compression = more pain or decreased rotation = lesion is probably meniscus damage
McMurray test - meniscus
Pt supine, tested knee fully flexed.
Rotate tibia medically and bring knee into extension.
Repeat process with different angles of knee flexion in order to test whole posterior aspect of lateral meniscus.
To test medial meniscus - knee in full flexion and laterally rotate tibia.
+’ve = pt experiences clicking, locking or pain in the knee.
Thessaly test - meniscus
First test the uninsured leg, before you move on to the injured leg.
Pt standing on injured leg, 20 degrees knee flexion.
Pt can hold onto you for support.
The rotate in both directions over the tibia, 3 times in each side.
+’ve test = patient complains about pain in the joint line during rotations.
Reverse lachman test - PLC (posterior lateral complex)
Injuries Often happen due to direct blows to the anterior medial knee.
Pt in supine, knee flexed to 90 degrees.
Bring tibia into external rotation with ipsilateral hand.
Contralateral hand on the proximal lateral tibia to apply a valgus stress and apply an axial load through the tibia with your distal arm or with your iliac crest.
If pt has posterior lateral rotary instability = subluxation of the lateral tibial plateau posteriorly.
Then passively extend the patient’s leg while keeping the external rotation valgus force and axial load.
At around 30 degrees of knee flexion, the ITB changes from a flexion vector to an extension vector and will therefore pull the tibia anteriorly which reduces the rotary subluxation. This test is positive = if a clunk is heard when the tibia
reduces at around 30 degrees of flexion. Be aware though that the awake pt might not permit this maneuver and this test can be considered positive in case of apprehension
Posterior sag sign - PCL
Pt in supine with hip flexed to 45 degrees and the knee flexed to 90 degrees, While the patient is encouraged to relax quads, view the knee from the side.
Test +’ve for torn PCL = step between tibia which usually extends 1cm anteriorly in relation to femur is lost .
Test can be progressed into the Godfrey sign for which a posterior sag is noted in case of a torn PCL when the patients hips and knees are flexed to 90 degrees and patients heels supported by examiner.
In this test, the posterior sag becomes more prominent.
To further confirm findings, ask pt to actively extend knee while fixating their hips in 90-10p degrees of hip flexion. Through the contraction of the quads, tibia will shift anteriorly again to its normal position in case of a torn PCL.
+’ve posterior sag sign = con cavity distal to the patella
Posterior drawer test -PCL
Pt in supine, hip flexed to 45 degrees and knee flexed to 90.
Fixate this position by slightly sitting on pt’s foot.
Palpate the joint line and push the tibia posteriorly in an explosive movement.
+’ve test = tibia translate posteriorly more than 6mm or if you experience a soft and wooshy end feel.
Valgus stress test - MCL
Pt in supine with legs fully extended.
Instruct patient to relax as much as possible during the test.
With one hand, grab onto the lower leg, just above the ankle joint, and the other hand is used to fixate the femur.
Slightly externally rotate the tibia and perform passive abduction in the knee joint and thus putting stress on the medial collateral ligament.
Looking for excessive gapping on the medial side and the reproduction of pain.
Can do the test again, with 20-30 degrees of flexion.
Varus stress test - LCL
Pt in supine with legs fully extended.
Instruct pt to relax as much as possible.
Grab onto lower leg with one hand just above the ankle joint and fixate with the other hand on the medial side of the femur.
Apply lateral rotation in the knee joint and perform passive adduction in the knee joint to put stress on the LCL.
Perform the same test but with knee in 20-30 degrees of flexion.
Looking for excessive gapping on the lateral side of the knee joint as well as pain reproduction.
Patellofemoral apprehension test (instability)
Pt either in supine or sitting on the bed with knee flexed to 30 degrees.
Quads must be relaxed to allow passive movement of patella.
With your thumbs, press on the medial side of the patella to exert laterally directed pressure.
+’ve test = pt may be surprised by the lateral displacement of the patella and feel uncomfortable or apprehensive as the patella reaches the point of maximal lateral displacement.
Clarke’s sign (patellofemoral pathology)
Pt in supine.
Stand next to pt on the involved side and place we space of the thumb on the superior border of the patella.
Ask the pt o contract the quads as if they were to extend the knee, while you apply a downward and inferior pressure on the patella.
+’ve test = pain with movement of the patella, or inability to complete the test = patella femoral dysfunction.
Patellar tap test (knee swelling)
Pt in supine, fully extended leg.
Stroke downwards just until you reach the suprapatellar pouch and press downwards.
Other hand - perform same movement and stop just below the apex of the patella.
While applying downward pressure, take one finger and press onto the patella and see whether it is floating.
If you can feel that the patella is floating when you’re tapping onto it, this means that the fluid has accumulated under it and it is an indication for swelling in the knee joint.
