, with the proximal hand usually holding the foot (or shin if the ankle is painful) rotate the tibia on the femur, both internally and externally in turn. Pain usually indicates injury to the menisci.

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Video 6: Normal PCL test - note no sag on release of proximal arm

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Video 8: Normal MCL and LCL

the joint line reveals tenderness. This may be the only indicator of injury. Make sure the examining finger is not below the joint line, as tenderness here usually is related to the coronary ligaments (the guy-rope type ligaments which bind the menisci to the tibial plateau). Stressing the menisci may cause no pain even with injury. Either place the proximal hand on the femur, as in the Lachman test, the knee at 90o

A slightly more complicated test is to twist the tibia to full rotation in a scooping-like action both internally and laterally rotating (video 9). Again pain usually indicates injury. If the patient can achieve 90o

flexion of the knee, turn

them prone and repeat the rotating action, grinding the tibia into the knee. This also tests the menisci (video 10). Pulling the knee apart and repeating the action shouldn’t illicit pain from the menisci (video 11).

Muscle test To test power I bend the knee to 90o

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Video 7: Normal MCL

knee may demonstrate posterior shift towards the bed (video 6).

Collateral ligaments (MCL/LCL) Collateral ligament tests need practice. For the medial collateral ligament (MCL), bend the knee to 15-20o

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Video 9: Grinding the menisci in suppine

flexion,

then either place the proximal hand flat on the lateral aspect of the knee, with the distal hand flat on the medial aspect of the upper shin. Push the examining hands in opposite directions – medially and laterally respectively (video 7). Two technique points:

1. A straight knee locks the collateral ligaments and invalidates the test. 2. Stopping the leg rotating during this is vital as hip rotation can give the impression of a lax MCL.

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Trap the foot under the arm of the distal hand to control rotation. An intact MCL gives a firm end-feel. Occasional complete rupture is painless and shouldn’t be missed, the distance of travel is usually worryingly large and rapidly reversed by the examiner. The lateral collateral ligament (LCL) is much less commonly injured but is tested with the hands in opposite positions. An alternative is to place both hands around the head of the tibia (like the anterior draw test), but rhythmically move the hands side to side straining the MCL when pushing laterally and vice versa (video 8).

Meniscal tests

These are a combination of palpation and stress movement. Palpation over

foot on the bed and ask the patient to resist my pulling their heel away. This tests the hamstring power. Placing the proximal hand under tibia and trying to push the heel to their bottom tests the quads muscle. Closed chain exercises i.e. with the feet fixed also gives a good idea of muscle power. I accept that the tests are only fairly gross measures of power. However unlike the shoulder, muscle power is not as important. Muscle power is more important in controlling knee pain after injury. However you examine these

muscles develop a routine you can use reliably and quickly. Modify the instructions so the patient understands.

Injured muscles that are not working for one day, take three days to rehabilitate.

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Feel By now you should be 90% sure of the lesion location. Palpation of the joint line will usually indicate meniscal injury. With the tip of the index finger (nail

sportEX medicine 2010;45(Jul):7-12

KEY POINT: Muscles experiencing pain cannot contract fully.