Knee Ligament & articular tests

Anterior Drawer:

• The client lies supine on a plinth with their hips flexed to 45 degrees, his/her knees flexed to 90 degrees and feet flat on the plinth.
• The examiner sits on the toes of the tested extremity to help stabilize it. The examiner grasps the proximal lower leg, just below the tibial plateau or tibiofemoral joint line, and attempts to translate the lower leg anteriorly.
• The test is considered positive if there is a lack of end feel or excessive anterior translation relative to the contralateral side

Posterior Drawer:

• The patient is supine and the knee to be tested is flexed to approximately 90 degrees.
• The examiner then sits on the toes of the tested extremity to help stabilize it. The examiner grasps the proximal lower leg, approximately at the tibial plateau or joint line with the thumbs placed on the tibial tuberosity. Then the examiner attempts to translate the lower leg posteriorly.
• The test is considered positive if there is a lack of end feel or excessive posterior translation

Lachman's (ACL):

• Lie the patient supine on the bed. Place the patient's knee in about 20-30 degrees flexion. According to Bates' Guide to Physical Examination, the leg should also be externally rotated slightly. The examiner should place one hand behind the tibia and the other on the patient's thigh. It is important that the examiner's thumb be on the tibial tuberosity. On pulling the tibia anteriorly, an intact ACL should prevent forward translational movement of the tibia on the femur ("firm end-feel").
• Anterior translation of the tibia associated with a soft or a mushy end-feel indicates a positive test. More than about 2mm of anterior translation compared to the uninvolved knee suggests a torn ACL ("soft end-feel"), as does 10mm of total anterior translation.

MCL Stress Test (Valgus):

• The examiner places one hand at the outside of the knee, acting as a pivot point, while the other hand is placed at the foot. The medial joint line is palpated while the examiner simultaneously applies an abducting force at the the foot, and a valgus force through the knee joint.
• This test is typically performed at both 30 and 0 degrees of knee flexion. When performed at 30 degrees, the MCL is more isolated from other medial joint structures, with a sensitivity of .86-.96 for MCL tears.
• This can be followed by performing the second version of the test, at 0 degrees of knee flexion, which allows for assessment of other medial joint structures.

LCL Stress Test (Varus):

• The test is performed by stabilizing the femur and palpating the lateral joint line. The other hand provides a varus stress to the ankle.
• The test is performed at 0° and 20-30°, so the knee joint is in the closed packed position.
• The physiotherapist stabilize the knee with one hand, while the other hand adducts the ankle.
• A positive tests is if the knee adducts greater than normal and/or elicits pain.

McMurray Meniscal Test

• Client is supine, with the examiner holding the knee and palpating the joint line with one hand, thumb on one side and fingers on the other, whilst the other hand holds the sole of the foot and acts to support the limb and provide the required movement through range.
• From a position of maximal flexion, extend the knee with internal rotation (IR) of the tibia and a VARUS stress, then return to maximal flexion and extend the knee with external rotation (ER) of the tibia and a VALGUS stress.
• The IR of the tibia followed by extension, the examiner can test the entire posterior horn to the middle segment of the meniscus. The anterior portion of the meniscus is not easily tested because the pressure to that part of the meniscus is not as great.

IR of the tibia + Varus stress = lateral meniscus

ER of the tibia + Valgus stress = medial meniscus

• Positive findings: Pain, snapping, audible clicking or locking can indicate a compromised meniscus.

Thessaly's Meniscal Test

• The patient stands flat footed on one leg while the examiner supports the patient by holding their outstretched hands.
• The patient then flexes the knee to 5° and rotates the femur on the tibia medially and laterally three times, while maintaining the 5° flexion.
• The test is then repeated at 20° flexion.
• The test is considered positive for a meniscus tear if the patient experiences medial or lateral joint line discomfort or a sense of locking/ catching in the knee

Patellofemoral Glides

• Patello-femoral glides