Knee Orthopedic Tests

Knee Orthopedic Tests are usually used to assess the knee and find out the cause of knee pain, knee clicking and crunching, or knee pain when walking or running.

Knee Orthopedic Tests


 

Knee Orthopedic Test : True Tibia and Femur Length Test:

Testing for:

The tibia and femur lengths

 Procedure:

• Patient is prone

• Patient’s knees and hips flexed , with the plantar surfaces of their feet on the table.

• Their medial malleoli even and knees together

 To compare the lengths:

• Tibia: Therapist stands at the foot of the table to compare the heights of the patient’s tibial plateaus to look for the shorter tibia

• Femur: Then therapist stands at the side of the table to compare the positions of the patellas looking for the shorter femur.


 

Knee Orthopedic Test : Noble’s Test

Testing for:

The presence of iliotibial band (ITB) friction syndrome

 Procedure:

• Patient is supine, with both their affected side’s knee and hip flexed to 90° degrees

• Therapist compresses the iliotibial band (ITB) – 2 centimetres proximal to the lateral femoral condyle

• Instruct the patient to extend the knee and hip slowly while therapist maintains compression of the ITB proximal to the lateral femoral condyle

 Positive Sign:

Pain over the lateral femoral condyle at about 30° degrees of knee extension.


 

Knee Orthopedic Test : Gravity Drawer Test (aka Posterior Sign)

 Purpose:

To assess the integrity of the posterior cruciate ligament

 Procedure:

• Client is supine, their hips flexed to 45 degrees and their knees flexed to 90 degrees and their feet are flat on the table

• Observe the profile of both knees from the side of the table

Positive Sign:

The affected tibia sags posteriorly compared to the unaffected knee. (In given position, the tibia drops posteriorly on the femur if the posterior cruciate ligament’s integrity is compromised)

Knee Orthopedic Test : Waldron’s Test

 Testing for:

The Presence of patellofemoral syndrome

 Procedure:

• Client is standing

• Therapist palpates the patella while the client performs knee bends

 Positive Sign:

Presence of pain, crepitus, poor patellar tracking


 

Knee Orthopedic Test : Major Effusion Test (aka Ballottable Patella)

Purpose:

Usually performed after an injury to assess for a major increase in the synovial fluid or blood within the knee joint capsule

 Procedure:

• Client is supine, the affected knee is extended as much as possible ( with effusion, client may not be able to extend their knee fully)

• Therapist gently extends the knee further, then compresses the patella down on to the condyles then release

 Positive Sign:

Patella clicks onto the femur and then rebounds to the floating position. This could be caused by torn cruciate ligaments, meniscal tearing, or fracture and is considered a Medical Emergency. (Joint effusion within two hours of injury might be caused by blood in the joint, and joint effusion with synovial fluid usually develops 8 hours after injury.


 

Knee Orthopedic Test : Minor Effusion Test ( aka Brush Test)

 Purpose:

To assess for lesser amounts of synovial fluid within the knee joint right after an injury. This is usually done after the Major Effusion Test comes up negative.

Procedure:

• Client is supine, their affected knee is extended as much as they can

• Therapist slowly sweeps the effusion from the superior lateral aspect of the knee and suprapatellar pouch.

Positive Sign:

A bulge inferior to the patella appears within two seconds, the positive test will indicate from 4-8 millimeters of extra synovial fluid within the joint. This could be caused by cruciate or meniscal damage and is considered a Medical Emergency.


 

Knee Orthopedic Test: Q ( Quadriceps ) Angle

Note: The Q angle is the angle between the quadriceps tendon and the patellar tendon. The Q-angle is formed from a line drawn from the ASIS to the center of the kneecap, and from the center of the kneecap to the tibial tubercle. To find the Q-angle, measure that angle, and subtract from 180 degrees.

 To Measure Q Angle:

• Patient is standing, with the knee in extension ( femur neutral: no internal or external rotation ) and patient’s feet in a neutral position ( no pronation or supination).

 Normal Test Result:

A normal Q angle with the knee extended and the quadriceps muscle relaxed is 18° degrees for women and 13° degrees for men.

 • A Q angle that is less than normal allows the patella to track medially between femoral condyles, placing extra stress on the medial articulating facets of the patella which leads to Chondromalacia Patellae

• A Q angle that is greater than normal allows the patella to track laterally, stressing the lateral facets which is associated with patellar tracking dysfunction, chondromalacia patellae and patellar subluxation.

 

 

Knee Orthopedic Test : Valgus Stress Test of the Knee

Testing for:

The integrity of the structures that prevent Valgus deformity of the knee (Joint capsule, medial collateral ligament, cruciate ligaments)

 Procedure:

• Client is supine

• Place the affected leg in extension and slight external rotation. Stabilize with one hand on the medial malleolus and with the other hand stabilize the lateral aspect of the knee.

• Apply a medially directed stress on the lateral knee

• Flex their knee to 30 degrees and apply the same pressure on the lateral side to isolate the medial collateral ligament

 Positive Sign:

Presence of pain and hypermobility at the medial aspect of the knee


 

Knee Orthopedic Test : Varus Stress Test of the Knee

Testing For:

The integrity of the structures that prevent lateral instability at the knee (lateral collateral ligament, joint capsule, cruciate ligaments).

 Procedure:

• Patient is supine with the affected knee in full extension.

• Therapist stabilizes the affected leg in slight external rotation with one hand on the lateral malleolus.

• Therapist places their other hand on the medial aspect of the knee.

• Therapist applies a laterally directed (a varus) stress on the medial knee.

• Flex their knee to 30 degrees and apply the same pressure on the lateral side to isolate the lateral collateral ligament

 

Positive Sign:

Presence of pain and hypermobility at the lateral aspect of the knee


 

Knee Orthopedic Test : Lachman’s Test

 Testing for :

The integrity of the Anterior Cruciate Ligament (ACL). The Lachman’s test is considered to be the most accurate test for ACL integrity.

 Procedure 1:

• Patient is supine.

• Patient’s affected knee is flexed 30°

• Therapist stabilizes distal femur with one hand while grasping patient’s proximal tibia with the other hand

• Therapist applies an anteriorly directed stress the tibia.

 

Procedure 2:

• Patient is seated with their affected leg over the edge of the table

• Therapist sits in front of the patient, supporting the patient’s ankle on therapist’s thigh.

• Therapist places patient’s knee in 30° flexion

• Therapist stabilizes the distal femur with one hand

• Therapist applies anteriorly directed stress on the proximal tibia with the other hand.

 Positive Sign:

Pain or excessive anterior motion of the tibia, and disappearance of the infrapatellar tendon slope.


 

Knee Orthopedic Test : Patellar Apprehension Test

 Purpose:

To test whether the patella is likely to dislocate laterally

 Procedure:

• Patient is supine with their affected knee extended

• Therapists uses a slow and moderate pressure against the medial aspect of the patella moving it in a lateral direction

• Therapist observes patient’s reaction

 Positive Sign:

Patient expresses apprehension and/ or might try to move their affected knee away from the pressure.


 

Knee Orthopedic Test : Helfet’s Test

 Testing for:

the dynamic rotary function of the Tibia ( possible torn meniscus or injured cruciate ligament)

 Procedure:

 • Patient is seated, with their legs hanging over the edge of the table

• Patient’s knees flexed to 90° ( so the tibial tuberosity is perpendicular to the midline of the patella)

• Therapist slowly extend the patient’s knee

• As the knee is slowly extended, the Therapist observes the relative alignment of the tibial tuberosity to the midline of the patella. ( Therapist can also palpate the movement of the tibial tuberosity).

 * Since the medial femoral condyle is about 1 cm. longer than the lateral femoral condyle, the tibia first moves over the available lateral condyle surface and then must rotate laterally when we extend the knee.

* it’s impossible to perform helfet’s test if there is knee joint effusion

 Positive Sign:

Absense of slight lateral tibial motion = this positive sign may indicate that a torn meniscus or injured cruciate ligament is physically blocking the knee extension.


 

Knee Orthopedic Test: McMurray’s Test

 Testing for:

Injury to the Menisci

 Procedure:

 • Patient is supine, their affected hip and knee are flexed

• Therapist cups one hand over the patient’s knee ( palm over the patella and fingers/thumb over the joint line )

• Therapist grasps patient’s heel with the other hand

• Therapist slowly extends the patient’s knee, while applying different stresses ( #s 1 & 2 below) to check both menisci.

1: external rotation of the tibia and valgus stress on the knee to assess medial meniscus

2: internal rotation of the tibia and varus stress on the knee to assess lateral meniscus

 Positive Sign:

Click or Catch in the extension of the knee. ( A negative test does not completely rule out meniscal tear)


 

Knee Orthopedic Test : Bragard’s Sign

 Testing for:

Meniscal Tearing

 Procedure 1: Extension of the knee and External Rotation of the Tibia

• Patient is supine with affected hip and knee flexed

• Therapist stabilizes proximal to the knee with one hand while externally rotating the tibia with the other hand = while extending the knee

 Positive Sign:

– Pain or tenderness along the medial aspect of the joint line indicates medial meniscus injury.

 

Procedure 2: Internal Rotation of the Tibia & Extension of the knee

• Patient is supine with affected hip and knee flexed

• Therapist stabilizes proximal to the knee with one hand while internally rotating the tibia with the other hand = while extending the knee

 Positive Sign:

– Pain or tenderness along the lateral aspect of the joint line indicates lateral meniscus injury.


 

Knee Orthopedic Test : Apley’s Compression Test

 Testing for:

Meniscal Injury

 Procedure:

 • Patient is prone.

• Patient then flexes affected knee to 90°

• Therapist’s one hand grasps patient’s heel and ankle while the other hand stabilizes the leg.

• Therapist compresses the flexed knee joint and the menisci –by pushing the patient’s foot and tibia down into the table, followed by internal and external rotation of the tibia.

 Positive Sign:

Pain on the medial aspect = medial meniscus damage/injury

Pain on the lateral aspect = lateral meniscus injury/damage


 

Knee Orthopedic Test : Apley’s Distraction Test

 Testing for:

The Integrity of the Collateral Knee Ligaments

 Procedure:

• Patient is prone, with their affected knee flexed 90°

• Therapist places their own knee on patient’s posterior thigh to stabilize

• Therapist grasps patient’s leg proximal to the ankle

• Therapist applies traction to the tibia towards the ceiling ( this distracts the knee joint) –then apply internal and external rotation of the tibia while tractioning.

Positive Sign:

Pain on the medial side = medial collateral ligament damage/ injury

Pain on the lateral side = lateral collateral ligament damage/ injury


 

Knee Orthopedic Test: Coronary Ligamentous Stress Test

 Testing for:

The integrity of the Coronary Ligament

 Procedure:

• Patient is seated, their knee flexed to 90°

• Therapist passively externally rotates the tibia on the femur

 Positive Sign:

Pain on external rotation of the tibia indicates coronary ligament sprain. (With sprain of the coronary ligament, valgus stress test does not cause pain).

Knee Orthopedic Test : Clarke’s Patellofemoral Grind Test

Testing for:

Patellofemoral Syndrome

 Procedure:

 • Patient is supine with their knees extended

• Therapist compresses the patella posteriorly onto the femoral condyles and then, moderately move the patella distally

• Therapist instructs patient to contract the quadriceps muscles ( to pull patella proximally)

 Positive Sign:

Pain, crepitus, apprehension of the patient as the irritated surfaces of the patella rub over the femur.

Knee Orthopedic Test : McConnell’s Test

Testing for:

Patellofemoral Tracking problems

 Procedure:

Part I:

• Patient is seated with legs hanging over the end of the table

• Therapist sits in front of the client

• Therapist instructs patient to externally rotate the femur of the affected leg while performing active resisted isometric contractions of the quadriceps muscles at 0, 30, 60, 90 and 120 degrees of flexion.

• Therapist notes the painful degrees/ ranges

Part II:

• Therapist passively brings the patient’s knee to full extension, resting the heel on something so the patient relaxes the quadriceps muscles

• then, Therapist glides the affected patella medially and hold the patella it in that position

• Therapist instructs patient to perform isometric contractions at the knee ranges that were painful before

Part III:

• Therapist passively brings the patient’s knee to full extension, resting the heel on something so the patient relaxes the quadriceps muscles

• then, Therapist glides the affected patella laterally and hold the patella it in that position

• Therapist instructs patient to perform isometric contractions at the knee ranges that were painful before

 Positive Test:

– Pain decreases significantly after holding patella medially = patellofemoral lateral tracking problems

– Pain decreases significantly after holding patella laterally = patellofemoral medial tracking problems