knee exam

1. Knee Examination
Abdulaziz Al-Ahaideb
MD,FRCSC

2. Orthopedic physical exam:
Look
Feel
Move
Special tests

3. Look (always compare)
Alignment ( normal, varus or valgus)
Effusion
Scars
Wasting
Color
P.S. don’t forget to inspect the posterior aspect ( e.g. Baker’s cyst)

10. Feel
Temperature (compare)
Tenderness ( feel the bony prominences)
Effusion (fluid collection)
* fluctuation
* bulging (milking)
* ballotment (patellar tapping)

11. Move
Active ( by the patient)
Passive ( by the physician)
Feel for crepitus when you take the knee through the range of motion

12. Special tests
Meniscus
Stability

13. Meniscal exam
Tenderness in the medial joint line (medial meniscus)
Tenderness in the lateral joint line (lateral meniscus)
McMurrey’s test for medial and lateral meniscus: (VC*)

14. Stability
 To test the four ligaments of the knee:
 MCL (Medial Collateral Ligament)
 LCL (Lateral Collateral Ligament)
 ACL (Anterior Cruciate Ligament)
 PCL (Posterior Cruciate Ligament)

15. Stability
 MCL : Valgus stress test
 LCL : Varus stress test

16. Valgus stress test ( for MCL ) (VC*)

17. ACL exam
Anterior drawer
test:
Excessive
forward
movement of the
tibia on the femur

18. ACL exam
Lachman’s test
(VC*):
The most sensitive
test for ACL rupture

19. ACL exam
Pivot shift test:
When positive, it is painful
It needs experience to be able
to elicit it

20. PCL exam
Posterior drawer test
(VC*):
excessive backward
movement of the tibia in
relation to the femur.

21. PCL exam
Sagging sign: compare both
knees in 90 degrees of flexion.
In the injured knee the proximal tibia is
displaced backwards compared to the other
side.

22. Sagging Sign

23. Patellar Apprehension test
 For recurrent patellar
dislocations/subluxations

24. Thanks