Knee examination

Question 1

Look

Answer 1

limb alignment
gait
skin changes/brusing/scars/swelling

Question 2

what abnormalities of limb alignment do you look for

Answer 2

valgus
varus
muscle mass variation
popliteal fossa

Question 3

what is varus

Answer 3

bow leg

Question 4

what is valgus

Answer 4

knock knee

Question 5

Feel

Answer 5

Temperature
Tibial tuberosity
Patella tendon
Medial and lateral joint line
Medial and lateral collateral ligaments
Popliteal fossa
Bursa

Question 6

Move

Answer 6

active and passive flexion- feel for crepitus
extension

Question 7

what does straight leg raise test assess

Answer 7

intact extensor mechanism

Question 8

what are the tests for effusion

Answer 8

medial gutter sweep
patella tap

Question 9

what does steinmans test assess

Answer 9

meniscal provocation test (meniscal tear)

Question 10

what does the collateral ligament test assess

Answer 10

stressing of the medial and lateral ligaments

Question 11

what do the cruciate ligaments tests assess

Answer 11

PCL/ACL
posterior/anterior drawer

Question 12

what do the cruciate ligaments tests assess

Answer 12

PCL/ACL
posterior/anterior drawer

Question 13

what does heel height testing suggest

Answer 13

with a history of a locked knee and suggestive of a meniscal tear to look for restricted extension

Question 14

what are the patella tests

Answer 14

Patella apprehension tests (patella instability)
Patella grind test (patella-femoral OA)

Question 15

how do you do the patella grind test

Answer 15

with the knee in extension and relaxed exert a downward pressure on the patella and move the patella from side to side.
Positive test = discomfort is reported by the patient

Question 16

how do you do the patella apprehension test

Answer 16

with the knee in extension and relaxed, gently exert a pressure to push the patella laterally (+/- begin to flex the knee) and observe the patient’s face for apprehension.
Positive test = the patient appears apprehensive during the test.

Question 17

how do you do steinmans test

Answer 17

With the knee flexed throughout this test use one hand to find the point of joint line tenderness on the knee and place the other hand under the foot (holding the heel).
If the point of tenderness is on the medial side rotate the foot externally. If this is on the lateral side, rotate the foot internally.
Positive test = exacerbation of the patient’s discomfort during the test.

Question 18

how do you test the collateral ligaments

Answer 18

Palpate the lateral and medial collateral ligaments for tenderness. Abduct the hip and passively flex the knee to 20degrees over the side of the couch.
With the patient relaxed use both hands (one at the ankle and the other at the side of the knee) to exert a valgus force (tests medial ligaments) and then swap the position of your hands to exert a varus force (tests lateral ligaments).
Positive test = tenderness on palpation without laxity suggests a sprain. Laxity on valgus (medial) or varus (lateral) stress suggests a tear.

Question 19

how do you do the posterior drawer test

Answer 19

with a flexed knee, immobilise the foot on the couch and then push the tibia backwards with both hands.

Positive test = if the PCL is torn there may be a visible posterior tibial sag on initial inspection or during the posterior movement of the drawer test, which confirms PCL laxity

Question 20

what is Lachman’s test

Answer 20

with the patient relaxed, passively flex the knee to 20 degrees, by lifting the femur with one hand on the thigh. The other hand holds the tibia (with fingers round the calf and the thumb on the tibial tuberosity). In this position steady the hand on the femur and pull the tibia forward to look for anterior movement of the tibia. The ACL prevents subluxation of the tibia on the femur, so if it is intact it should prevent forward translational movement.
Positive test: A torn ACL will exhibit laxity by increased anterior translational movement without a firm end point compared to the contralateral side

*alternative to anterior drawer test