Evaluation of the Knee


LSU Physician Champion - Dr. Gary Glynn


Inspection

Examine the knees visually for asymmetry, quadriceps atrophy, genu valgum (knock-knee), genu varum (bow-leggedness), erythema, edema, masses, scars or other deformities. It is important to inspect the knees while the patient is both non-weight bearing and weight bearing, as well as during the gait cycle.

Palpation

 
Feel for tenderness, crepitus, effusions, warmth or clicks. In particular, the medial and lateral joint lines, pes anserinus bursa, prepatellar bursa, infrapatellar bursa and the posterior fossa should all be palpated.

Ranges of Motion

 
Feel for tenderness, crepitus, effusions, warmth or clicks. In particular, the medial and lateral joint lines, pes anserinus bursa, prepatellar bursa, infrapatellar bursa and the posterior fossa should all be palpated.



Special Assessment


These tests individually and considered together, can be very helpful, but are not always completely diagnostic.

Patellar Ballotement Test


With the patient supine and the knee passively extended, the examiner taps the patella against the femur. A positive test is when the patella “bounces”, especially in comparison to the contralateral side, and suggestive of a knee effusion.

Patellar Grind Test


With the patient supine and the knee extended, the examiner places an open hand and abducted thumb around the superior patella. Downward force is applied as the patient contracts the quadriceps. A positive test is pain around the patella and suggestive of patellofemoral dysfunction.

Lachman’s Test


With the patient supine and the knee flexed around 15, the examiner places one hand on the distal femur and one on the proximal tibia. Anterior force is exerted on the tibia and posterior force is exerted on the femur. A positive test is similar to the Anterior Drawer Test.

Posterior Drawer Test


The patient is supine with the knee and hip flexed. The examiner exerts posterior force on the tibia as if closing a drawer. A positive test is a lack of a fixed solid endpoint with posterior motion, especially in comparison to the contralateral side, and suggestive of a posterior cruciate ligament tear.


Special Tests


McMurray's Test

 
With the patient supine, the examiner holds the patient’s heel with one hand and places the other on the medial joint line. The knee is fully flexed, internally rotated, and then extended. This is repeated with a hand on the lateral joint line and the knee instead externally rotated. A positive test is pain or clicking along the respective medial or lateral joint lines and suggestive of medial or lateral meniscal pathology.

Valgus Stress Test

 
With the patient supine the examiner provides a valgus force (lateral to medial) at the knee while stabilizing the ankle. This is done both with the knee in full extension and at 30 of flexion. A positive test is medial knee pain or loss of a solid-endpoint compared to the contralateral side, and suggestive of a medial collateral ligament sprain or tear.

Varus Stress Test

 
With the patient supine the examiner provides a varus force (medial to lateral) at the knee while stabilizing the ankle. This is done both with the knee in full extension and at 30 of flexion. A positive test is lateral knee pain or loss of a solid-endpoint compared to the contralateral side, and suggestive of a lateral collateral ligament sprain or tear.




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