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(English captions by Andrea Matsumoto from the University of Michigan)

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To ensure a thorough assessment it is best[br]to preform the musculoskeletal exam of the

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knee in a systematic way.

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

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used for evaluating knee 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[br]atrophy, symmetry of the patellar alignment,

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evidence of varus or valgus positioning of[br]the knee, or presence of pes planus or pes

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cavus of the foot.

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

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many toes" sign.

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

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

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

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Next observe the gait looking for an antalgic[br]gait 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 range[br]of motion passively.

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In a seated position test for knee extension.

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In this position also observe patellar tracking.

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And, internal and external rotation of the[br]hip which can help identify referred knee

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pain caused by hip pathology.

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Also in the seated position, palpate anatomic[br]landmarks for tenderness.

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Palpate the distal quadriceps, quadriceps[br]tendon, the patella, patellar tendon, the

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tibial tuberosity, and the fat pads beneath[br]the patella.

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On the medial side palpate the medial collateral[br]ligament, the medial joint line, the pes anserine

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bursa.

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On the lateral side, the lateral collateral[br]ligament, the lateral joint line, and the

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fibular head.

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

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With the patient supine the leg can be fully[br]extended to assess better for joint diffusion.

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Compress the suprapatellar pouch, pushing[br]the contents distally, and assess for increased

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fluid.

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Patellar ballottement can also be performed[br]by compressing the patella and releasing quickly.

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Observe for rapid rebound, which also indicated[br]increased fluid pressure.

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If a click or tap is felt a large effusion[br]is present, also called the ballottable patella.

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The patellar grind test assesses for patella-femoral[br]syndrome.

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With the knee extended push the patella into[br]the trochlear groove of the femur.

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Pain is a positive test.

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The patellar inhibition test assess for patella-femoral[br]syndrome also.

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With the knee extended, push the superior[br]aspect of the patella inferiorly as the patient

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tightens the quadriceps muscle.

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Pain or crepitus is considered a positive[br]test.

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The patellar apprehension test evaluates for[br]patellar subluxation of dislocation.

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With the knee extended push medially and laterally[br]on the patella in an attempt to sublux the

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patella.

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If it is painful or the patient becomes apprehensive[br]about the movement it is a positive test.

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There are several tests commonly performed[br]to evaluate for ligamentous laxity of the

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knee.

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Medial collateral ligament stability can be[br]tested at zero degrees and thirty degrees

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of flexion by applying a valgus force on the[br]knee.

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Lateral collateral ligament stability can[br]also be tested at zero degrees and thirty

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degrees of flexion by applying a varus force[br]to the knee.

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Laxity indicates a partial or complete ligamentous[br]tear.

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The Lachman�s test evaluates for a tear[br]of the anterior cruciate ligament.

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With the knee flexed to thirty degrees, stabilize[br]the femur and pull the proximal tibia anteriorly.

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Excessive motion or soft endpoint is a positive[br]test.

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The anterior drawer test assesses of a tear[br]of the anterior cruciate ligament also.

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With the knee flexed to ninety degrees and[br]the foot planted on the table, push the proximal

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tibia anteriorly.

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Excessive motion or soft endpoint is a positive[br]test.

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The posterior drawer test assesses for a tear[br]of the posterior cruciate ligament.

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With the knee flexed at ninety degrees and[br]the foot planted on the table, push the proximal

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tibia posteriorly.

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Excessive motion or a soft endpoint is a positive[br]test.

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The PCL sag test evaluates for a tear of the[br]posterior cruciate ligament.

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With both knees flexed to ninety degrees and[br]feet planted on the table, view the knees

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from the side to compare the position of the[br]tibia.

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Increased posterior sag of one of the tibias[br]is considered a positive test.

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The McMurray�s test evaluates for a miniscule[br]tear.

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With the patient supine and knee fully flexed,[br]palpate the medial joint line and apply an

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axial force along the tibia while externally[br]rotating and extending the knee.

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This maneuver is repeated palpating the lateral[br]joint line while internally rotating the foot.

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Pain, catching, or palpable clunk indicates[br]a miniscule tear.

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The bounce test also evaluates for a miniscule[br]tear.

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Grasp the heel, extend, and bounce the leg,[br]gently forcing hyperextension.

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Pain is a positive test.

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In the prone position, Apley�s compression[br]test evaluates for a miniscule tear.

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Flex the knee to ninety degrees, apply an[br]axial force along the tibia, and rotate the

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tibia.

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Pain is a positive test.

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Ober�s test assesses for iliotibial band[br]syndrome.

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With the patient in the lateral position,[br]the knee is supported and flexed to ninety

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degrees.

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Then extend and abduct the hip and release[br]the knee support.

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Failure of the knee to adduct is a positive[br]test.

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In the seated position, Noble�s test can[br]also be used to evaluate for iliotibial band

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syndrome.

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With the knee flexed to ninety degrees, apply[br]pressure over the lateral femoral chondral

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and passively extend the knee.

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Lateral pain around thirty degrees of flexion[br]is a positive test.

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In concluding the knee exam, it's important[br]to document a neurovascular exam.

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Here we demonstrate dorsalis pedis artery[br]pulse, posterior tibial artery pulse, and

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capillary refill testing.

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A more thorough exam may be indicated based[br]on patient history.