Knee examination

Question 1

what is the structure of a knee exam?

Answer 1

stand the patient 
walk the patient 
sit the patient 
lie the patient 
asses ligaments 
special tests

Question 2

why do we stand the patient?

Answer 2

Look for scars (knee replacement = long scar down middle of knee), swelling (back of knees), deformities

Question 3

why do we walk the patient?

Answer 3

Look at symmetry in gait, bowlegged, knock knees

Question 4

what do we check when the patient is seated?

Answer 4

Assess patella height (should be the same) and tracking (ask to bend and straighten and hold patella), put hand on knee may have creaking in arthritis

Question 5

what do we look for when the patient is lying down?

Answer 5

Look, feel, move the knee joint 
Flexion and extension of joint 
Feel:
Medial joint line 
Lateral joint line 
Patella 
Ask patient to bend both knees and put feet and ankles together on bed (asses femur length, tibia sagging backwards in a PCL rupture)

Question 6

how do we assess the MCL?

Answer 6

valgus stress test:

apply inward pressure on lateral thigh with one hand while applying outward pressure from medial ankle with other hand

Question 7

how do we asses the LCL?

Answer 7

varus stress test:

outward pressure at medial thigh with one hand and inward pressure from lateral ankle with other hand

Question 8

how do we asses the PCL?

Answer 8

posterior drawer test:

pushes backward on tibia when leg is bend and foot on couch, looking fo posterior sag of the tibia

Question 9

how do we asses ACL?

Answer 9

anterior drawer test:
tibia drawn towards you with the leg bent and foot on couch, a torn ACL will cause the tibia to move further anteriorly
lachman’s test:
stabilise femur with one hand and use the other to pull the tibia anteriorly and posteriorly against the femur