Knee Examination

This article is a stub.

Observation from front

• Weight distrubtion
• Deformity (varus/valgus)
• Swellings (loss of concavities)
• Scars
• Redness/rashes
• Wasting (vastus medialis most prominent)

Observation from lateral side

• Hyperextension deformity
• Fixed flexion deformity
• Swellings (e.g. meniscal cyst)

Observation from behind

• Muscle wasting (e.g. calf)
• Swelling (e.g. semimembranosus bursa, ruptured bakers cyst)

Gait

• Limp (decreased stance phase – painful, or equal stance phase – non painful e.g. from flexion contracture)
• Shoulder tilts to the painful side
• Heel strike, stance, toe off

Screening for internal derangement

• Squatting
• Duck walk

Palpation of muscles (knee extended)

Patella

• Patella (margin, muscle and tendon insertions. Push patella medial side and palpate medially and inferior pole, push laterally and palpate laterally and inferior pole)
• Patella apprehension test (push laterally and flex 30-40 degrees, rule in and out instability)

OA

• Crepitus/grind test (push down on patella and flex/ext, look for pain with crepitus rather than crepitus alone)

Fluid

• Swipe test
• patella tap

Palpation from side

• Knee is now flexed
• Landmarks (lower pole patella is right in joint margin between medial femoral condyle, flat tibial plateau, lateral femoral condyle)
• Feel for sore meniscus, capsule, osteophytes along line
• Tibiofibula joint subluxation

Further palpation of landmarks

• Tibial tubercle
• Gerdeys tubercle (iliotibial band insertion)
• Adductor tubercle
• Medial epicondyle femur, MCL, medial condyl tibia
• Lateral epicondyle femur, LCL, head of fibula
• Popliteal artery

Movements

• Do all as active, passive and resisted
• Knee flexion
• Knee extension
• Quads lag/extensor lag

Ligaments

• Stress varus/valgus (rule out MCL)

Cruciates

• Ski jump sign (posterior sag)
• Anterior drawer (rule in ACL)
• Pivot shift test (rule in ACL)
• Lachman test (rule out ACL)
• Posterior drawer

Meniscus

• Thessaly test (rule in + out meniscus)
• Bounce test/snap test (poor)
• Apley grind test (poor)
• McMurrays (poor)