Examination of the Knee joint- orthopaedics and surgery The clinical evaluation of the knee is a fundamental tool to correctly address diagnosis and treatment, and should never be replaced by the findings retrieved by the imaging studies carried on the patient

1. Examination of
Knee Joint
Dr Abu Shuraih Sakhri

2. HISTORY
• pain,
• swelling, stiffness
• mechanical symptoms (e.g. locking, giving
way, click etc)
• limp
• deformity

3. • mechanism of trauma
• Position of knee at time of trauma
• After trauma, was the patient able to continue
playing
• post trauma - weight bearing possible or not,

4. • what treatment taken, how long immobilised
• pain – aggravated
• giving way – aggravating factors
• recurrent swelling of knee

5. • When did the effusion occur after the trauma
(if immediate .. think of # intraarticular if
delayed, think of meniscal injury)
• Any h/o Clicks, thuds, giving away?
• Any h/o locking / unlocking
• Difficulty in climbing stairs, squatting

6. • Other joints
• Renal diseases

7. General examination
• Ligamentous laxity
• Neurocutaneous markers
• Fetures of rickets **

8. • Have examined the patient in standing sitting
lying down position
• From front side and back

9. • Attitude
• GAIT
• Inspection
• Palpation
• Movement
• Measurement
• Special test
• Neurovascular ex (common peroneal)
• Other joints

10. Attitude
• Optimal position
• Triple displacement – flexion, post.
Subluxation, lateral rotn of tibia
• Genu valgum
• Genu varum
• Genu recurvatum
• locking

11. Inspection
• Skin (scar, sinus ,discoloration)
• Swelling (effusion,bursitis, Baker’s cyst,
tumors,malunion)
• Muscle wasting

12. Palpation
• Local rise of temp
• Tenderness
– Anterior, medial and lateral joint line tenderness

13. collateral ligament
• tenderness is characteristically present at its
femoral attachment.
• Tenderness over the ligament at the level of
the joint without any tenderness at its bony
attachments is suggestive more of an injury to
the Menisci and less of the sprain of the
collateral ligament.

14. • Tenderness at the joint level midway between
the ligamentum patellae and the tibial
collateral ligament indicates torn anterior
horn of the medial semilunar cartilage.
• Tenderness posterior to the tibial collateral
ligament is diagnostic of a torn posterior horn.

15. • effusion in the knee joint
– 'patellar tap' and
– fluctuation tests

16. Fluctuation
• pressing the suprapatellar pouch with one
hand and feeling the
• impulse with the thumb and the fingers of the
other hand placed on either side of the
patella or the ligamentum patellae.

17. Patellar tap
• elicited by pressing the suprapatellar pouch
with one hand driving whole of its fluid into
the joint
• so as to float the patella in front of the joint
• With the index finger of other hand the
patella is pushed backwards towards the
• femoral condyles with a sharp and jerky
movement. The patella can be felt
to strike on the femur

18. swelling in the popliteal fossa
• expansile pulsation - Popliteal aneurysm
• Transillumination test - Morrant-Baker cyst
• compressible

19. Palpation of popliteal fossa
• Swelling
• Poplietal artery

20. Palpation
• all the bones around the knee joint
• Thickening and irregularity
– patella,
– lower part of the femur and
– upper ends of the tibia and the fibula
• pathology or tumour

21. Palpate the patella
• Tracking
• Margins
• Push patella laterally and medially

22. MOVEMENTS
• flexion
• extension.
• active and passive movements

23. MEASUREMENTS
Circumference measurement- OF THIGH from
ASIS … quadriceps wasting
• Intermalleolar distance
• Intercondylar measurement

24. Intermalleolar distance
Intercondylar distance
on standing

25. Special Test for
• Menisci
• Collateral ligament
• Cruciate ligament

26. McMurray’s test
• detect any tear in the medial / lateral menisci
• grasps the foot firmly with one hand and the
knee with the other hand.
• joint is completely FLEXED
• The foot is now rotated externally and the leg
abducted at the knee.
• then the joint is slowly extended keeping the foot
externally rotated and abducted.
• PAIN OR CLICK – medial meniscus tear
• Foot int.rotn+ leg adduction- lateral meniscus

27. • If the posterior end of the medial semilunar
cartilage is torn
• the patient will complain of pain at start
• middle of the menisci is torn then - middle of
extension
• when the anterior horn is torn - felt almost at
the end of extension.

28. Apley’s Grinding test
• The patient lies prone on the table.
• The clinician places his knee on the patient's thigh in
order to fix the femur.
• The knee joint is flexed to the right angle.
• Now the clinician applies compression and lateral
rotation
• to the leg from the foot i.e. grinding.
• medial semilunar cartilage.
• If the patient complains of pain while the clinician
• compresses and internally rotates the leg, there is a
• tear in lateral semilunar cartilage.

29. ACL
• ANTERIOR DRAWER TEST
• Supine, 90 degree flexed knee
• Hold upper tibia by two hands
• Pull applied at upper end of tibia+ forward
movmt in realtion to femoral condyles
• Normal- glide up to 0.5cm
• >0.5- lig laxity

30. Lachman test
• 15-20 degree flexion- knee
• One hand support thigh just above the knee ,
other grasps the upper end of tibia
• Extend of anterior glide indicate integrity of
ACL

31. PCL
Backward sagging of upper end of tibia – lig
injury
POSTERIOR DRAWER TEST
• How much it is possible to push the tibia
backwards…

32. • Examination of hip
• Examination of foot and ankle
• Distal neurovascular ex

33. In short
• Inspection
deformity, attitude, swelling , wasting, skin
• Palpation
T, tenderness,swelling, wasting
• Movements
• Measurements
• Ligaments and menisci
• Contralateral knee
• Hip
• Neurovascular

34. THANK YOU