Knee Lab

Question 1

tibiofemoral open pack

Answer 1

25 degrees flexion

Question 2

patellofemoral open pack

Answer 2

5-10 knee flexion

Question 3

AP glide of tibia - joint assessment and treatment

Answer 3

achieve indirectly by PA of femur with stabilized tibia in supine
in prone, prop femur with towel and push tibia forward

Question 4

tib/fib distraction

Answer 4

seated position
hold tibial plateaus, squeeze leg with knees or use figure 8 gait belt to pull down

Question 5

patellar tilt

Answer 5

open pack 5-10 degrees
med and lateral base should feel equal
palpate with length of thumb at edge of patella

Question 6

patellar glides

Answer 6

inferior, superior, medial, lateral, med/lat rotation, tilt

Question 7

superior AP/PA fibular glide

Answer 7

supine
knee bent, anchoring to table
thumb on fibular head, fingers posterior into gastroc
PA use fingers on gastroc to pull anterior

Question 8

anterior drawer

Answer 8

purpose: assess ACL integrity, acute injury or repair
position: supine, hip flexed 45 knee flexed 90
action: anchor foot by sitting on it, quickly translate tibia forward
positive: excess translation of tibia compared to uninvolved
*hamstrings will try to protect, why it needs to be fast

Question 9

Lachman’s

Answer 9

purpose: assess ACL integrity, acute and post op
position: knee flexed 20-30, knee supports femur
action: translate tibia anteriorly quickly
positive: excess tibia anterior translation

Question 10

Lelli’s

Answer 10

purpose: assess ACL integrity
position: supine, fist under pt tibia 3 fingers under joint line
action: press femur down
positive: without ACL, tibia will not move upwards on the lever system

Question 11

posterior drawer

Answer 11

purpose: assess PCL integrity
position: supine, hip 45 knee 90
action: posterior translation of tibia with hands on proximal tibia, doesn’t need to be fast
positive: excess posterior translation of tibia

Question 12

posterior sag sign

Answer 12

purpose: assess PCL integrity
position: supine, hip 45 knee 90
action: observe tibial plateau compared to femoral condyles
positive: loss of step with tibial plateau sagging behind femoral condyles

Question 13

valgus stress test

Answer 13

purpose: assess integrity of MCL
position: supine, edge of table, knee 0 and 30
action: valgus stress to lateral knee, tibia in ER
positive: reproduce pain or laxity; positive in 0 indicates larger tissue disruption

Question 14

varus stress test

Answer 14

purpose: assess integrity of LCL
position: supine, leg edge of table
action: varus stress to medial knee at 0 and 30
positive: reproduction of pain or laxity, positive in 0 indicates larger tissue disruption

Question 15

Pivot shift test

Answer 15

purpose: assess ACL integrity
position: supine, extended knee, slight hip flexion/abduction, 30 degrees IR at hip
action: hold lat calcaneus for IR, apply valgus force and flex knee
positive: tibia relocates backwards at 30-40 degrees knee flexion, clunk/giving way

Question 16

McMurray

Answer 16

purpose: assess meniscus
position: supine, knee in max flexion
lateral - IR tibia
medial - ER tibia
action: extend knee
positive: reproduce click/pop or pain

Question 17

Thessaly

Answer 17

purpose: more provocative meniscus assessment
position: standing on affected leg, holding PT or table for support
action: pt rotates body so leg int/ext rotates w knee flexed 5 degrees then 25
positive: reproduce pain, click

Question 18

Patellar apprehension

Answer 18

purpose: assess patellar instability
position: supine, leg off the table in 30 knee flexion
action: passively translate patella laterally
positive: pt expresses apprehension, quad contraction to prevent patellar dislocation

Question 19

Clarke’s

Answer 19

purpose: assess patellofemoral pain
position: supine
action: pt performs quad set while PT glides patella distally
positive: familiar pain, inability to hold quad set

Question 20

Noble Compression Test

Answer 20

purpose: assess IT band syndrome
position: supine, knee flexed 90
action: apply pressure to lat femoral epicondyle over IT band, maintain and passively extend knee
positive: pain over lateral femoral condyle

Question 21

stroke test

Answer 21

purpose: assess joint edema
position: supine
action: stroke from medial tib femoral joint upward suprapatellar, then down laterally
positive: fluid observed on medial knee, 0-5 scale

Question 22

ottawa knee rules

Answer 22

used after trauma
- Age >55 years
- Isolated patellar tenderness without other bone tenderness
- Tenderness of the fibular head
- Inability to flex the knee to 90°
- Inability to bear weight immediately after injury and in the emergency department (4 steps) regardless of limping

Question 23

Apley compression/distraction

Answer 23

purpose: general diagnostic
position: prone, knee flexed 90
action: compress or distract with rotation
compression would irritate joint surface, meniscus
distraction wouldn’t

Question 24

mobilization for last 5 degrees of extension

Answer 24

stabilize tibia, held in ER
give femur post glide with IR for screw home mechanism

Question 25

mobilization for lacking 5-15 degrees knee extension

Answer 25

AP on femur

Question 26

mobilization for knee flexion

Answer 26

flex to barrier
perform tibial IR and post glide
AP to tibia

Question 27

patellofemoral glides improve what motion?

Answer 27

inferior glide improves: flexion
superior glide improves: extension

Question 28

manual treatment for patellar tendinopathy

Answer 28

cross friction massage to tendon