This document describes various special tests and mobilization techniques for the knee joint. It outlines tests to assess the integrity of ligaments like the ACL, PCL, MCL and LCL. These include anterior drawer, posterior drawer, valgus stress, varus stress, Lachman's and pivot shift tests. It also describes tests for meniscal injuries like McMurray's test. The document concludes by explaining knee joint mobilization techniques like anterior glide, posterior glide, and rotational glides of the tibia.

1. Special Tests and
Mobilization of Knee Joint
Presented By:
Dr. Muhammad Sohail Raza

2. Overview of Knee Anatomy:
• Consists of Three distinct articulations:
1) Medial Tibiofemoral Joint
2) Lateral Tibiofemoral Joint
3) Patellofemoral Joint
• Stabilized on either side of Collateral Ligaments:
1) Medial Collateral Ligaments
2) Lateral Collateral Ligaments
3) Anterior Cruciate Ligament
4) Posterior Cruciate Ligament
5) Oblique Popliteal Ligament
6) Arcuate Popliteal Ligament
7) Patellar Ligament ( Patellar Ligament)
• Menisci:
1) Medial Meniscus
2) Lateral Meniscus

3. Bursae around Knee Joint:

4. Special Test for Assessment
of Knee Joint Pathologies:

5. Anterior Drawer Test
• Purpose: ACL Integrity
• Patient Position: Supine with knee flex 90◦ and foot placed
on Couch.
• Clinician position: The patient’s foot is stabilized by sitting
on the dorsum of the forefoot. Both hands grasp around
the upper tibia with thumbs placed anteriorly over the
joint line
• Action: Apply a posterior-to-anteriorly directed force
through the superior tibia. Compare the involved side to
the non-involved side.
• Positive Test: A positive test includes the lack of an end-feel
or excessive translation.

6. Posterior Drawer Test:
• Purpose: To assess the integrity of the PCL.
• Patient Position: Supine with the hip flexed to 45° , the knee
flexed to 90 ° and the foot placed on the couch.
• Clinician Position: The lower leg is stabilized by sitting on
the dorsum of the forefoot. Both hands grasp around the upper
tibia with thumbs placed anteriorly over the joint line with the
thenar area of both hands positioned over the upper tibia.
• Action: The tibia is pushed backwards with both hands.
The absence of an end-feel or excessive translation compared
to the non-involved side is a positive test.

7. Valgus Stress Test:
• Purpose: To primarily detect pain and/or laxity of the medial
collateral ligament (MCL).
• Patient Position: Lying supine with the leg relaxed.
• Clinician Position: Standing on the outside of the affected leg;
the patient’s lower leg is lifted and supported between the waist
and the inside of the clinician’s elbow with the knee flexed to
about 20– 30 ° and the hip positioned in a degree of internal
rotation and abduction. The heel of the outside hand is placed
just above the lateral joint line, the inside hand is placed just
below the medial joint line where the thumb can palpate the
medial tibiofemoral joint line.
• Action: Firm inward pressure is applied with the outside hand
and outward pressure with the inside hand while rotating the
body away from the end of the couch to achieve a valgus
stress to the knee. The test can then be repeated with the knee
in full extension.
• Positive Test: The reproduction of medial knee pain alone is
suggestive of injury to the MCL

8. Varus Stress Test:
• Purpose: Detect pain and/or laxity of the lateral collateral
ligament (LCL)
• Patient Position: Lying supine towards the edge of the couch.
• Clinician Position: Standing on effected side in Between
abducted leg and couch. The patient’s lower leg is supported
between the waist and the outer elbow and the hip is
positioned in some degree of internal rotation. The heel of the
outside hand is placed on the upper tibia just below the lateral
joint line and the inside hand is placed just above the medial
joint line on the lower femur.
• Action: With the knee in about 20 ° of flexion and the hip
internally rotated, firm pressure is applied with both hands
to achieve a Varus stress while rotating the body in order to
increase leverage.
• Positive test: Lateral knee pain or laxity on stress testing.

9. Lachman’s test:
• Purpose : Detect anterior (one-plane) instability and anterior
cruciate ligament (ACL) laxity.
• Patient Position: Supine with knee 10 to 30 degree flexion.
• Clinician Position: The patient’s foot is stabilized between
the clinician’s thigh and the couch. The outside hand is
placed over the lateral aspect of the thigh just above the
knee joint and the fingers wrapped around the back of the
lower thigh while counter-pressure is applied anteriorly
with the thumb.
• Action: With the outside hand stabilizing the femur, the
lower hand firmly pulls the tibia forwards in an attempt to
generate anterior translation.
• Positive Test: Increased anterior excursion of the tibia on the
femur with an accompanying change in the end-feel usually
indicates a significant injury

10. Pivot shift test:
• Purpose: To assess for anterolateral rotational instability
(ALRI) and laxity of the anterior cruciate ligament (ACL).
• Patient Position: The patient lies supine with hip is flexed to
45° and abducted to about 30° with the knee in 50° of flexion.
• Clinician Position: The tibia is internally rotated by using the
heel as a lever with the thumb of the caudal hand over the
lateral border of the calcaneus and the fingers gripping
medially. The cephalic hand is placed on the outside of the leg
just below the knee joint
• Action: A valgus stress is applied with the cephalic hand
as the knee is moved towards extension.
• Positive Test: The lateral tibial condyle subluxes
forwards on the tibial plateau as the knee approaches
extension. As a result Pain feels.

11. Reverse pivot shift test :
• Purpose: Assess for posterolateral rotatory instability (PLRI).
• Patient Position: Supine with the leg relaxed. The hip is
flexed to about 45 ° and the knee taken into about 80° flexion.
• Clinician Position: Caudal Hand grasps the heel with forearm
support medial border of foot and Cephalic Hand supports
knee.
• Action: The caudal hand maintains the external rotation of the
tibia, at the same time applying a valgus stress to the knee.
The knee is then allowed to extend slowly and at
around 20 – 30 ° of flexion, the iliotibial band then lies
anterior to the axis of rotation, In this position, the tibia
would be subluxed posterolaterally for Indication of
positive test.

12. Dial test:
• Purpose: To assess for posterolateral rotatory instability
(PLRI)
• Patient Position: Lying supine with the thigh abducted so
that the knee can flex over the side of the couch.
• Clinician Position: The thigh is stabilized with the
cephalic hand while the other hand grasps the heel and
uses the forearm to push the foot into dorsiflexion.
• Action: Using the dorsiflexed foot as a lever, the knee is
passively flexed to 30 ° and externally rotated. The extent
of rotation is noted in comparison to the other knee but an
excess of 10 ° is considered to be a positive test. Then
test is then repeated in 90 ° of flexion, still with the thigh
comfortably supported on the couch

13. McMurray Test
• Purpose: To elicit pain and/or apprehension resulting from
meniscal injury or pathology
• Patient Position: Supine lying
• Clinician Position: Towards effected limb with patient’s Hip
and Knee flexed.
• Action: From heel of foot Tibia rotated externally.
• Positive test: Reproduction of the patient’s pain, click or
apprehension.

14. Knee Joint Mobilizations

15. Anterior Glide:
• Anterior glide is used to increase joint play and capsular stretch to
encourage external rotation and extension ROM.

16. Posterior Glide
• The patient is positioned in supine with the knee slightly flexed and a prop placed under
the distal femur. The stabilizing hand is used to prop the distal femur and the mobilizing
hand is placed over the proximal tibia just below the tibial tuberosity. The mobilization
itself is performed by a force perpendicular to the line of the tibia. This technique is useful
for obtaining joint play necessary for knee flexion.

17. Rotational Glide:
• Internal and external rotation glides are useful for gaining joint play for knee flexion and extension, respectively.
These glides can be performed at various points in the normal ROM of the knee with the patient positioned in
supine. The stabilizing hand grasps the distal femur and the mobilizing hand grasps the heel of the patient's foot. The
ankle is maximally dorsiflexed so that rotational motion is applied to the rotating tibia and not at other joints more
distally. The foot is either rotated medially or laterally, depending on the mobilization preferred (internal or external
rotation) and at the range where restriction may be apparent.

18. Patellofemoral Glides:
• Patellofemoral glides are used when restriction of the patellofemoral
joint causes pain or decreased overall knee ROM/function.