Consider asking which side is the patient's kicking foot if they are a sportsperson
Check for general lower leg alignment (valgus or varus deformity), scars or sinuses, swelling in the posterior aspect of the knee (Baker's cyst)
Indicative of pain
Check for swelling in the anterior aspect of the knee, position (valgus/varus/partially flexed/hyperextended), bruising, quadriceps wasting, posterior sag with knee flexed at 90 deg
Use back of hands and compare sides
A Baker's cyst is usually just below the joint line, a semimembranous bursa just above. A popliteal cyst related to the popliteal artery is pulsatile.
Tests for an effusion - empty the medial suprapatellar pouch by stroking the fluid in a superior direction then milk the fluid back into the knee from above on the lateral side and watch for reaccumulation of medial fluid
Normally the knee will flex such that the calf meets the posterior thigh. A hand should be placed over the patella to feel for PFJ crepitus when passively flexing up the knee and returning it to supine resting position (extension)
Patient supine – hold both legs by the toes looking for fixed flexion or hyperextension
Knee on pillow in 20-30 deg flexion and gently push the patella laterally – positive test if the patient develops apprehension and describes a feeling of impending dislocation
Apply valgus force to the knee in full extension and then at 30 deg flexion looking for pain, extent of valgus movement and an end point. Repeat with varus stress. There is normally some mediolateral movement at 30 deg but if excessive compared to the normal side suggests collateral ligament instability (injury)
Knee is flexed and at various stages IR and ER of the tibia is performed. Fingers on joint line – palpable clunk is consistent with release of a torn meniscus trapped between articular surfaces. Pain alone may suggest meniscal damage BUT may be related to other pathology e.g. medial joint line OA, PFJ abnormality
With knee in 90 deg flexion and the foot stabilised. Ensure hamstrings are relaxed with index fingers on femoral condyles draw the tibia anteriorly and assess degree of movement and end point compared to the opposite side (ACL)
As per anterior drawer except grip the tibia firmly and push it posteriorly again assessing for movement and end point quality (PCL)
Knee in 15 deg flexion, draw the tibia forwards feeling for laxity and end point compared to the opposite side (ACL)
Items Completed: 0 / 41
Score: 0%