Knee Examination Abdulaziz Alomar MD MSc FRCSC Assistant

Knee Examination Abdulaziz Alomar, MD, MSc, FRCSC Assistant Professor and Consultant Orthopaedic and Sport Medicine Surgeon

General MSK Physical Examination Principles for Lower Examination • • Exposure Bilateral limb examination Anterior and posterior Gait LLD NV examination Joint above and joint below

Gait • Antalgic gait • Stiff knee gait • Flexed knee gait

Knee Examination • Look (Inspection) • Feel (Palpation) • Move • Special tests

Inspection (Look) • • • Deformity Scars Swelling Skin colour changes Muscle wasting

Muscle wasting

Deformity

Scars

Localize Swelling

Defuse swelling (Effusion)

Feel (palpation) • Temperature • Tenderness • Effusion

Tenderness • Soft tissue • Bony prominences • Joint line

Surface anatomy

Joint line palpation

Effusion Ballotment Milking

MOVE Active ROM Passive ROM

ROM • Flexion contracture • Extension lag

Special tests • Ligaments (stability): – ACL (Anterior Cruciate Ligament) – PCL (Posterior Cruciate Ligament) – MCL (Medial Collateral Ligament) – LCL (Lateral Collateral Ligament) • meniscus • Patellofemoral joint

ACL (anterior cruciate ligament) Anterior drawer test • Excessive forward movement of the tibia on the femur

ACL (anterior cruciate ligament) Lachman’s test • The most sensitive test for ACL rupture • Anterior Translation and end point (soft vs. hard)

ACL (anterior cruciate ligament) Pivot shift test: When positive, it is painful It needs experience to be able to elicit it

PCL (posterior cruciate ligament) Posterior drawer test • excessive backward movement of the tibia in relation to the femur.

PCL (posterior cruciate ligament) 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.

MCL Full extension 15 degree flexion

LCL Full extension 15 degree of flextion

Meniscus • Joint line tenderness: – Tenderness in the medial joint line (medial meniscus) – Tenderness in the lateral joint line (lateral meniscus) • Mc. Murrey’s test for medial and lateral meniscus

Patella apprehension test