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(English captions by Trisha Paul from the University of Michigan)

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To ensure a thorough assessment, it is best to perform the musculoskeletal exam of the knee in a

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systematic way.

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The following is a suggested order of[br]exam that incorporates many of the common

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techniques used for evaluating the[br]injuries.

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Begin the exam with the patient in the standing[br]position.

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Look for evidence of gross deformity, muscular atrophy,

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symmetry of the patellar alignment,

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evidence of varus or valgas[br]positioning of the knee

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or presence of pes planus and pes cavus of the foot.

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From a posterior view, observe for more than two toes laterally also called the too

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many toes sign.

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This can indicate an over-pronated[br]foot or an abducted fore foot.

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Have the patient perform a toe raise and evaluate the heel position.

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Normally the heel should change from a[br]neutral to a varus position.

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Next observe the gait,

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looking for an antalgic gate

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or excessive pronation or supination.

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Next, evaluate active range of motion.

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If pain or limitation exists, repeat the[br]range of motion passively. In a seated

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position, test for knee extension.

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In this position, also observe

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patellar tracking.

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and internal and external rotation of[br]the hip

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which can help identify referred knee pain[br]caused by hip pathology.

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Also in this seated position, palpate anatomic landmarks for tenderness.

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Palpate the distal quadriceps, quadriceps tendon,

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the patella,

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and patellar tendon,

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the tibial tuberosity,

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and the fat pads beneath the patella.

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On the medial side,

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palpate the medial collateral ligament,

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the medial joint line,

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the pes anserine bursa,

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and on the lateral side, the lateral[br]collateral ligament,

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the lateral joint line,

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and the fibular head.

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Posteriorly palpate the popliteal fossa[br]and the distal hamstrings.