Knee Exam and Eval

Question 1

A lumbar scan is done in patients in whom you suspect which two pathologies?

Answer 1

OA and patella-femoral patients (overuse patients)

Question 2

Which muscles are always tested in a knee patient? (these muscles all relate to gait and stability)

Answer 2

quads, hamstrings, gastroc soleus, hip abductors

Question 3

Effusion tests

Answer 3

1. patella ballottement
2. fluctuation test for moderate effusion
3. stroking
4. tape measure

Question 4

Effusion 2+

Answer 4

exercises not progressed

Question 5

2+ effusion even after RICE

Answer 5

contact physician regarding NSAIDS or aspiration

Question 6

effusion increasing more than 2 grades

Answer 6

decrease activity to level before the change in effusion occurred

Question 7

trace or less effusion

Answer 7

consider high level activity for return to sport

Question 8

MCL special tests

Answer 8

Valgus force at 0 and 10-30 degrees

Question 9

O degree valgus force test assesses which structures?

Answer 9

medial knee structures: capsule, MCL, plica, ACL, PCL

Question 10

30 degree valgus force assesses which structure?

Answer 10

MCL

Question 11

SN/SP of MCL special tests

Answer 11

high sensitivity, low specificity

Question 12

LCL special tests

Answer 12

varus force at 0 and 10-30 degrees

Question 13

When assessing MCL/LCL, do you start with the knee at 0 or 30 degrees of flexion?

Answer 13

always start at 30 and work your way to 0!

Question 14

zero degrees varus force test assesses which structures?

Answer 14

LCL, lateral capsule, ACL, PCL, arcuate-popliteus complex

Question 15

30 degrees varus force test assesses which structure?

Answer 15

laxity of LCL

Question 16

Lachman’s test

Answer 16

• very high SN and SP
• graded 0 - 3+
• test for ACL tears
• key: hamstrings must be relaxed or you may get a false negative
• pull tibia anteriorly to assess motion of tibia on femur

Question 17

Grading of Lachman’s and anterior drawer tests

Answer 17

0 = no anterior displacement
1+ = - 5mm translation
2+ = - 5 - 10 mm
3+ = > - 10 mm translation

Question 18

Anterior drawer test

Answer 18

• ACL test
• lower SN/SP than Lachman’s but specificity is high enough that if it is a positive test you know they have an ACL tear
• hamstrings play a big role in false negatives!
• same grading as Lachman’s

Question 19

Rotary instability - anterolateral pivot shift

Answer 19

• highly SN/SP
• determining how stretched out the capsule is
• rotation and forward glide of the tibia on the femur
• push tibia up and flex knee; looking for clunk/pop from ITB pulling tibia back into place during knee flexion

Question 20

Name the 3 major PCL tests

Answer 20

Godfrey’s, posterior drawer, reverse Lachman’s

Question 21

Godfrey’s

Answer 21

• PCL test
• SP = 1 !!!
• great at detecting chronic PCL tears, bad for acute tears
• hip and knee flexed at 90, looking for lack of tibial tuberosity presence. It slips posteriorly after chronic PCL tear

Question 22

Posterior Drawer test

Answer 22

• PCL test
• SN = .9
• SP = .99

Question 23

Reverse Lachman’s

Answer 23

SN = .62
SP = . 89
PCL test

Question 24

How do you test for a meniscal tear?

Answer 24

via joint line palpation
looking for tenderness
palpation better for detecting lateral vs medial meniscus tear

Question 25

Most common meniscus test?

Answer 25

McMurrey's

Question 26

McMurrey's Test

Answer 26

- SP = .94 for lateral meniscus tears - trying to pinch meniscus and get pop/click/pain by combining mvmts - start with knee hyperflexed and move it into extension - Medial meniscus test = ER thru tibia and varus force at the knee - lateral meniscus test - IR thru tibia and valgus force at knee

Question 27

Apley's compression test

Answer 27

for meniscal tears | apply pressure w/ pt in prone and knee flexed

Question 28

Q angle

Answer 28

- normal = 15 degrees - more than 20 = abnormal - lines from ASIS to patella and tibial tuberosity to patella - >20 changes alignment of quad on patella, putting the patella at a disadvantage and potentially causing pain

Question 29

Patellafemoral articulating surfaces

Answer 29

contract quad while pushing patella into femur looking for pain, but could also hurt a "normal" person without patella issues goal is to force articulating surfaces together

Question 30

Patella apprehension test

Answer 30

moving patella into sublux position (usually laterally) | goal is to reproduce pain

Question 31

Patella mobility

Answer 31

medial/lateral translation should be 1/3 the surface of the patella

Question 32

Joint mobility

Answer 32

patella femoral tibia femoral tibia fibula - proximal : LCL attaches here, check in patients with lateral knee pain, the joint can become hypermobile

Question 33

Functional tests

Answer 33

hop tests and running tests | pt needs to have 80% of strength in affected vs unaffected leg to return to sport. 90% for high-level athlete

Question 34

WOMAC

Answer 34

used for knee arthritis and pre/post TKA

Question 35

Lysholm knee scoring scale

Answer 35

commonly used as an evaluation method to assess post-surgical outcome results also used in research and ACL pts

Question 36

Pittsburgh knee rules

Answer 36

blunt trauma or fall Age 50 can't weightbear for 4 steps

Question 37

Ottawa knee rules

Answer 37

- age > 50 - isolated tenderness of patella - head of fibula tenderness - cannot flex knee to 90 - cannot walk 4 steps

Question 38

valgus force from trauma, think ____

Answer 38

ACL, MCL

Question 39

varus force from trauma, think _____

Answer 39

PCL, LCL