Knee Flashcards
Patient position and Goniometer alignment knee flexion
Patient in supine
Fulcrum: lateral epicondyle
Measuring arm: lateral malleolus
Stationary arm: greater trochanter
cues: flex knee, bring foot towards bum
End feel: soft due to muscle belly
Patient position and Goniometer alignment knee extension, end feel and cues
Patient in supine with towel under ankle
Fulcrum: lateral epicondyle
Measuring arm: lateral malleolus
Stationary arm: greater trochanter
cues: extend knee, straighten leg as much as possible
End feel: firm
Knee ROMs
Flexion: 135 degs
Extension: -5 to -10 degs
Lachman’s
assessing ACL integrity/laxity
patient supine with knee flexed 20-30 degs
secure femur with one hand and under tibia with other
Draw tibia anteriorly. Looking for excessive anterior translation of tibia
Positive test if there is soft/mushy end feel, pain or if the anterior translation of tibia is greater compared than uninjured leg
Anterior Drawer
assessing ACL integrity/laxity
patient supine with knee flexed 45-60 degs. Secure patients foot by sitting on it
cup tibia, and find joint line. Try to draw tibia anteriorly
Positive test if tibia translates anteriorly excessively compared to good side, pain or if you feel a soft/mushy end feel
Posterior Drawer
assess PCL laxity/integrity
patient supine with knee flexed 45-60 degs. Secure patients foot by sitting on it
cup tibia and palpate joint line. Push tibia posteriorly
test positive if tibia excessively translates posteriorly, if there is pain, or if there is a soft/mushy end feel
Sag sign
Assess PCL laxity/integrity
supine, with hip flexed to 45 degs and knee flexed to 90 degs
view affected knee
positive for a torn PCL if step between tibia is lost. Tibial tuberosity sagging under patella
Tibial tubercle rests more posteriorly than good side
Pivot Shift
assessing for anterolateral rotational instability (ALRI) and laxity of the anterior cruciate ligament (ACL).
patient in supine. hip flexed and abducted to 30 degs.
Cup calcaneus and induce tibial rotation. with other hand apply valgus force across knee from head of fibula which subluxes tibia anteriorly from the femur in extension. Move patients leg from extension to flexion
positive test if tibia reduces or is pulled posteriorly due to tightening of ITB and produced clunk sound
LCL - Varus Stress
assess LCL injuries/laxity/integrity
patient in supine. knee at 30 degree knee flexion. physio can sit on bed to support patients thigh.
secure ankle with one hand and fixate other hand on medial side of femur.
apply adduction along the tibia and a varus force across the knee
MCL - Valgus Stress
assess MCL injuries/laxity/integrity
patient in supine. knee at 30 degs of knee flexion. Secure ankle with one hand and place other hand around knee (near fibula head)
push medially (valgus force) against knee and laterally (abduct) against ankle to open knee joint on inside
looking for excessive gapping and movement and pain when comparing sides
McMurrays
assessing for meniscus damage
supine with knee fully flexed, cup calcaneus to rotate tibia
lateral meniscus: rotate tibia medially then move knee into extension with varus force across knee
medial meniscus: rotate tibia laterally then move knee into extension with valgus force across knee
positive if patient experiences clicking, locking or pain in knee
Apleys
assessing for meniscus damage
prone, fixate tested leg with your leg. bring knee into 90 degs flexion
distract leg and perform lateral and medial rotation of tibia
looking for excessive rotation compared to other side or discomfort
repeat same procedure while giving compression
looking for decreased rotation or discomfort
Reproduction of pain with compression indicates a meniscal tear.
Royal London Hospital
assessing for patella tendinopathy
patient in supine and patella tendon palpated for tenderness from proximal to distal from inferior pole
once local tenderness is elicited the tender portion of the tendon is palpated in 90 degs knee flexion
positive test if pain is markedly reduced or absent in knee flexion
Patella Tendon Palpation
assess patella tendinopathy
patient in supine, patella tendon palpated at attachment site over inferior pole of patella and along its whole length from proximal to distal.
Patient is asked about tenderness on palpation which indicates a positive test
Hoffa’s Test
assessing for fat pad impingement
The knee is flexed and each fat pad is tested by applying pressure to the medial or lateral side of the patellar tendon. Then the knee is passively extended while the pressure is maintained. This maneuver forces the pad into the patellofemoral joint thus exacerbating the pain.
The test is positive for impingement if pain and discomfort is felt during the last 10 degrees of knee extension.
