1. Physical Exam of the Knee
Inspection
Palpation
Range of Motion
Special tests
Neurovascular assessment

2. INSPECTION Effusion Q angle Erythema Angular deformities Ecchymosis
Edema
Q angle
Angular deformities
Muscular asymmetry

3. PALPATION ANTERIOR MEDIAL Tibial tubercle Infrapatellar tendon
Quad insertion
Patellar facets
Crepitus ?
MEDIAL
MCL
Meniscus
Pes anserine insertion
Tibial plateau
Femoral condyle

4. PALPATION LATERAL POSTERIOR Head of the fibula LCL
Meniscus
Tibial plateau
Femoral condyle
Gerdy’s tubercle
POSTERIOR
Menisci (posterior horns)
Popliteal fossa
Hamstring tendons

5. ACL Special Tests Anterior drawer Lachman test Pivot shift test
Valgus stress test at full extension!

7. Grading Ligament Injuries

8. ACL: PHYSICAL EXAM Decreased ROM Effusion-hemarthrosis, immediate
+ Instability tests
Lachman: most accurate
Pivot shift
Anterior drawer
+ MCL and meniscus tests

9. Translation + ENDPOINTS!
LIGAMENT EXAM
Translation + ENDPOINTS!

10. Ligamentous Instability
Valgus stress may sprain or tear the medial collateral ligament.
Varus stress may sprain or tear the lateral collateral ligament.
Both of these stresses with a rotational force may sprain or tear the anterior and/or posterior cruciate ligaments.

11. Ligamentous Instability
Clinical Signs and Symptoms
Knee pain
Limited range of motion
Difficulty in weight bearing
Joint effusion
Knee giving out; chronic unstable knee

12. MCL INJURIES HISTORY Mechanism = valgus stress Medial joint line pain
Lack of large effusion
Difficulty weight-bearing

13. MCL INJURIES PHYSICAL EXAM Tender to palpation along MCL
Pain + instability with valgus stress
30o flexion = MCL
90o flexion = associated ACL
Pain with Apley’s distraction test
COMPARE SIDES

14. PCL INJURIES Mechanism Effusion (less than with ACL)
Sports = fall on flexed knee with foot plantarflexed, hyperextension, pivot
MVA = dashboard injury
Effusion (less than with ACL)
Shifting/instability (chronic)
Less distinctive

15. PCL INJURIES PHYSICAL EXAM + Effusion + Posterior drawer test
+ Posterior sag sign
False positive Lachman test
Common to have isolated injuries

16. PATELLAR INSTABILITY Acute patellar dislocation
Acute patellar subluxation
Patellar tracking dysfunction

17. PATELLAR DISLOCATION History Mechanism = pivot Immediate effusion
May visualize patella dislocated laterally
+ Instability (chronically)
N.B. Patella spontaneously relocates

18. PATELLAR DISLOCATION Physical Exam Tender peripatellar structures
Medial retinaculum
Lateral femoral condyle
Effusion
? Patella dislocated laterally
Xrays- osteochondral fracture, effusion

19. PATELLAR DISLOCATION Treatment Knee extension immobilizer x 4 wks
Early quad setting exercises
PRE’s at 4 wks to pain tolerance
Return to sport
Full, painless ROM
Normal strength
Adequate aerobic fitness

20. MENISCAL INJURIES History
Mechanism = pivot, twist
+ heard a “pop”
Effusion o after injury
Mechanical Sxs- locking, instability

21. Meniscus Instability Clinical Signs and Symptoms
Local medial or lateral joint pain
Limited knee range of motion
Crepitus upon movement
Joint effusion
Knee buckling
Pain on walking up and down stairs
Pain on squatting

22. MENISCAL INJURIES Physical Exam
Joint line tenderness
IR/ER
Decreased ROM
McMurray’s test
Apley’s compression test

23. Apley’s Compression Test
Procedure: Patient prone. Flex leg to 90 degrees. Grasp the patient’s ankle and apply downward pressure while you internally and externally rotate the leg.
Positive Test: Flexing the knee distorts the meniscus. Downward pressure further stresses the meniscus. Pain or crepitus on either side indicates a meniscus injury on that side.