KNEE JOINT ASSESSMENT
Ligament tests for the knee There are many special tests for the knee joint these are some which are used for the more common problems.
■ Patella Patellar glide – gently hold patella between finger and thumb and passively flex and extend the knee joint. The test is positive if audible or palpable crepitus or pain occurs. This can indicate, osteoarthritis, a patellar tracking problem or chondramalacia patellae.
Patellar apprehension – patient supine leg extended and relaxed. Examiner has one hand below power patellar pole and the other above the upper pole. Thumbs touch on one side and index fingers on the other. Push patella medi- ally and laterally to point of restriction. Enquire if this movement causes any discomfort or feeling of instability. Positive if athlete is worried, uncomfortable or feels give way sensation. This indicates severe instability, previous sublaxation or dislocation.
Patellar compression – start position as above place hand over patella and gently press down on patella. Positive if there is any pain under or around the patella. This indicates injury of the patellofemoral joint.
■ Meniscus McMurray’s test – patient supine, hip and knee flexed to 90 degrees, examiner places one hand over thigh immediately above knee joint and holds patient’s heel with other. For medi- al meniscus test, start from extension and flex knee the examiner internally rotates the tibia and applies a varus force to the knee. For lateral meniscus test, reverse this movement and apply valgus stress on the knee as the tibia is externally rotat- ed. Positive gives pain, clunk or crepitus, varus force with internal rotation medial meniscus, valgus force with external rotation later- al meniscus. Indicates meniscal lesion.
Apley’s compression test – patient prone with knee flexed to 90o
. The examiner pushes down
on the foot to compress the knee joint and then rotates internally and externally to end range. Positive, pain and/or crepitus on rota- tion and compression. This indicates some meniscal pathology. Note pain and crepitus will be relieved by distracting the joint.
Bounce test – patient supine, leg relaxed, examiner lifts leg with one hand just below the knee joint and other holding above ankle. Lift leg and flex knee 10-15o
, let the knee fall
so that it bounces into extension. Positive is when pain is experienced as knee fully extends ie. on the bounce. This is an indication of meniscal lesion.
■ Collateral ligaments Medial collateral ligament test – valgus stress test - patient is supine, examiner lifts leg and flexes knee to maximum 30o
, stabilises lower
leg against own body and holds tibia just below joint. The tibia is then moved medially to gap the medial joint line. Positive pain or increased movement. Pain indicates medial collateral sprain, pain plus increased move- ment partial or more ligament disruption.
Lateral collateral ligament test – varus stress test - start point and position as for the val- gus but this time the examiner moves the lower leg laterally to stress the lateral joint line. Positive as above and indicates lateral collateral ligament problem.
■ Cruciate ligaments
Anterior cruciate ligament - anterior drawer test - patient supine, knee bent to 90o
. Stabilise
foot by sitting on it, both hands round proxi- mal end of tibia, pull the tibia anteriorly. Positive pain, excessive joint movement. This indicates sprain with pain and ligament disruption with excess movement.
Anterior cruciate ligament - Lachman’s test – patient supine, knee bent to 30o
. Examiner
has one hand above knee joint to stabilise femur and uses other to pull the tibia anteri- orly. Positive pain with normal movement or pain with increased movement. Pain and normal movement indicates anterior cruciate sprain, pain with increased movement indicates possible ACL rupture.
Posterior cruciate ligament - Reverse Lachman’s Test - the start position is exactly as the Lachman’s but this time the tibia is pushed posteriorly. Positive and indication are as above but for the posterior cruciate.
Posterior cruciate ligament - Posterior drawer test – start and position are the same as those for the anterior drawer test. This time the tibia is moved posteriorly. Positive and indi- cations are as above but this time it is the PCL that is damaged.
Note many clinicians grade ligament injuries ■ Grade 1 – Mild – less than 5mm of movement ■ Grade 2 – Moderate – 5 to 10mm of movement ■ Grade 3 – Severe – more than 10mm of movement.
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