The document summarizes the anatomy and clinical evaluation of the knee joint. It describes the knee as a modified hinge joint composed of the tibiofemoral and patellofemoral joints. Key anatomical structures including the menisci, cruciate ligaments, collateral ligaments, and muscles are outlined. The clinical evaluation involves obtaining a history of pain, swelling, instability, etc and performing an examination involving inspection, palpation, range of motion testing, and special tests of ligaments and menisci.

1. CLINICAL EVALUATION OF THE
KNEE

2. Knee joint is a MODIFIED HINGETYPE
BICONDYLAR SYNOVIAL JOINT.
Knee joint is a combination of 2 joints:
1).Tibiofemoral joint
2). Patellofemoral joint

3. ANATOMY

5.  MENISCI: medial & lateral
 CRUCIATES LIGAMENTS: acl & pcl
 COLLATERAL LIGAMENTS : medial & lateral

6. MENISCI
 Crescent shaped fibrocartilaginous structure.
 Fn as shock absorber,
depen articular surface,
provide stability to knee joint.

7. ACL & PCL
 ACL is distally attached to tibia (just ant. to
intercondylar eminence) & proximal to medial
wall of lateral femoral condyle.
 It prevents excess ant.translation of tibia over
femur
 PCL is attached proximally on the lateral wall of
MFC & distally to post. tibia 1-1.5 cm below
plateau in midline.
 It prevents excessive post. translation of tibia
over femur. it also helps in ‘screw home’(locking)
mechanism of knee.

8. MCL & LCL
 MCL is proximally attached on MFC just
below medial epicondyle & distally over
proximal medial tibia under pes anserinus.
 Fn : provides valgus stability to joint
especially in 30-90ᵒ flexion.
 LCL is proximally attached on lateral
epicondyle & distally over anterolateral part
of febular head.
 Fn: provides varus stability to joint in 5-30ᵒ
flexion

9. Posteromedial corner of knee
 Post. Oblique lig.(POL).
 Post. capsule
 Post. horn of medial meniscus
 semiM tendon
 Provides valgus stability in extension &
internal rotation stability.

10. Posterolateral corner of
knee
 LCL, popliteus tendon, popliteofibular
ligament, fabellofibular & arcuate ligament,
lateral capsule.
 It resists varus, external rotation & post.
translation forces on knee.

11. MPFL
 Stabilises patella into the trochlear groove
when knee flexes between 0-30ᵒ

12. Other facts:
 Normal alignment for knee is
4-7ᵒ valgus
 Normal ‘Q’ angle 14ᵒ-17ᵒ
 Patella ‘’increases lever arm
of quadriceps and hence,
enhances power of
quadriceps.’’
 Locking by quadriceps muscle
 Unlocking by popliteus

13. HISTORY & ITS EVALUATION
 PAIN (M/C)
 SWELLING
 INSTABILITY
 DIFFICULTY IN MOVEMENTS
 LOCKING,PSEUDOLOCKING
 CLICKS
 MALALIGNMENT/LIMB LENGTH
DISCREPANCY.

14. PAIN
ONSET
ACUTE
CHRONIC
TRAUMA
INFECTION
INFLAMMATORY,
DEGENERATIVE,
METABOLIC
DISORDER
NATURE
MECHANICAL
PAIN
REST PAIN
DEGENERATIVE
DISEASE,MENISCUS
INJURY,OA KNEE
INFLAMMATION,INFECTION,
TUMOUR (RA,TB)

15. SWELLING
IMMEDIATE/FEW HRS
AFTERTRAUMA
12-24 HRS
AFTERVTRAUMA
CHRONIC
HEMARTHROSIS
SYNOVIAL
EFFUSION(DUETO
SYNOVIAL REACTION)
EFFUSION/
SYNOVIAL
HYPERTROPH
Y/BOTH
ACUTE

16. INSTABILITY
 Pt complains of “My knee gives way/ I cannot
trust my knee” while running, jumping,
turning, stair-climbing, walking on uneven
ground, etc.

17. Locking
 Pathological condition when Knee is
Locked/Stuck in Flexed Position.
 Commonly observed in Bucket HandleTear.
 * The knee never gets locked in full extension*.
 Pseudo-locking: not a true locking ,but a
mere muscular spasm not allowing further
movements. Seen in Patellofemoral arthritis

18. Clicks/Thuds
 Commonly seen in Discoid lateral meniscus
 Also seen in Maltracking Patella, Meniscal
tear or loose bodies.

19. Malalignment
 GenuVarum(bow knee): Common in childhood
but resolves gradually, Also seen in OA,
Rickets, Paget’s Disease
 GenuValgum(knock knee) : Resolve by age of
6 years; commonly in females, Contributary
factor in Recurrent dislocation of patella,
Rickets,RA
 Genu Recurvatum : mostly due to joint laxity.
Sometimes Observed after Posterior Capsular
tear with PCL and PLC tears.

21. EXANINATION
 INSPECTION
 PALPATION
 MOVEMENTS
 MEASUREMENTS

22. INSPECTION
 1.DEFORMITY
 Coronal plane deformity-genu varum/valgum
 Sagittal plane deformity- flexion deformity/genu
recurvatum
 2. Muscle wasting-at thigh & calf.
 3. Limb length discrepancy-observe level of malleoli
& heel with both limb parallel to each other.
 4.positiopn of patella-normally rotated outwards &
LP is at level of joint line.
 5.swelling-I/A swelling gives rise to horse shoe
swelling.

23. PALPATION
a) local rise in temperature
b) tenderness over various bony & soft tissue
landmarks.
c) Swelling
d)Joint line tenderness- arthritis,meniscal
tear,mid substance collateral injury.
e) Patellar tap test- valid for moderate fluid.
f) stroke/bulge test for effusion.

24.  CREPITUS
 RETRO PATELLARTENDERNESS:to assess
patelofemoral cartilage health.
i) Patellar grinding test
ii) Facet tenderness
fixed
mobile
OA
LOOSE BODIES/MOBILE
MENISCUSTEAR

25. Patellar grinding test Patellar tap /Ballotment test.

26. MOVEMENTS
 FLEXION 0-140*
 EXTENSION normally 0*(occasionally 10-20*)
 Some rotatory movements as well.
 Extensor lag: a condition where in knee fails to
come back to neutral in full extension or point of
starting of flexion ‘actively’.
 It is due to disuse related weakness of quadriceps
muscle(not paralyzed).

27. MEASUREMENTS
 A) length of the limb:
ASIS to medial joint line(femur) & medial
joint line to medial malleolus(tibia).
 B) wasting of thigh & calf muscle:
Muscle girth is measured over max.thigh &
max.calf girth and compared with normal
side.
 C) Q angle: it is measure of lateral pull
exerted by quadriceps on patella.

28. Grade of ligament laxity
 Gr.0: <3 mm laxity/opening
 Gr.1: 3-5 mm laxity/opening
 Gr.2: 5-10 mm laxity/opening
 Gr.3: >10 mm laxity/opening

29. FOR ACL:
1.ANT.DRAWERTEST
2.LACHMANTEST (more sensitive)
3.PIVOT SHIFTTEST(more specific)
SPECIAL TESTS

30. TEST FOR PCL
 POST. DRAWERTEST
 POST. SAG SIGN
 GODFREY’S SAG SIGN
 QUADRICEPS ACTIVE
TEST

31. Cont.PCL test

32. TEST FOR MCL & LCL

33. VALGUS STRESSTEST VARUS STRESSTEST
+ in 0ᵒ ext/flex
+ in 30ᵒ flex.
only + in 0ᵒ ext/flex
+ in 30ᵒ
flex. only
Indicates tear
in cruciates +
posteromedial
structures(PM
capsule,POL,M
CL)
MCL
tear
only Indicates tear
of cruciates +
LCL
+posterolateral
structures.
LCL tear
only

34. MENISCAL TESTS
 1.McMurray’s test
 2.Apley’s grinding
test(compression
[meniscus] & distraction
[lig.] ) test
 3.Thessaly test: (most
sensitive & specific).

35. McMurray’s test
• Click/joint line
tenderness suggests
positive test

38. Posterolateral corner (PLC).
DIALTEST:>10ᵒ EXTERNAL
ROTATION INDICATES PLC
INSTABILITY.
ERRT: abnormal recurvatum at knee
& ER of leg suggest PLC injury

39.  In dial test if ER is more at 30ᵒ ‘only’, it implies
injured PLC & normal PCL.
 If ER is more at 30ᵒ & 90ᵒ it suggest PLC+PCL
injury.

40. Patella stability tests:
 1. fairbank’s apprehension test
 2.Quadrant test
 3.Patella horizontal tilt test
 4.patella maltracking (J-sign).

41.  Fairbank’s apprehension test: pt suoine &
knee in extension. Examiner holds patella b/w
thumb & index finger.patella is pushed
laterally by thumb while kne is gently flexed
from 0 to 30 and extended back to neutral
position.repeat same procedure few times.
 INTER: pt with RPD, shows apprehension on
face & stops examiner from performing
manoever.

42. Quadrant test:>=3 quadrant movements of
patella suggests medial or lateral soft tissue
injury.
Patella horizontal tilt test:

43. Patella maltracking (J-sign): CAUSE:
 Lateral retinacular
tightness
 VMO deficiency
 Increased Q angle
 Trochlear dysplasia
 Patella alta