Purpose: MCL integrity
How to perform: Patient is supine on the table. Both legs are extended, examiner then takes the tested leg with hand on the lateral side of knee and the other hand on the medial side of the ankle. The examiner than applies a valgus force to the knee testing the integrity of the MCL
(+): Excessive gapping at medial joint line, pain, and/or increased laxity at MCL = Indicates injury to the MCL
(-): no excessive gapping at medial joint line, pain, and/or increased laxity at MCL = indicates NO injury to the LCL
Purpose: LCL integrity
How to perform: Patient is supine on the table. Both legs are extended, examiner then takes the tested leg with hand on the medial side of knee and the other hand on the lateral side of the ankle. The examiner than applies a virus force to the knee testing the integrity of the LCL
(+): excessive gapping at medial joint line pain and/or increased laxity at LCL = Indicates injury to LCL
(-): no excessive gapping at lateral joint line, pain and/or increased laxity at LCL = Indicates no injury to LCL
Purpose: LCL integrity
How to perform: Patient is supine with legs straight. Examiner has 1 hand across the joint line of the tested knee, other hand on the medial plantar side of the foot. Examiner will then slowly bring tested knee up along the patient’s other straight leg until it creates a figure 4 position.
(+): recreation of pain as going into the figure 4 position = Indicates LCL sprain, complete or partial tear
(-): Recreation of pain when going into figure 4 position = Indicates no injury to the LCL
Purpose: ACL integrity
How to perform: There are 3 different ways to do a Lachman’s so I am going to describe grade 2 due to me being able to due grade 2 easier than the rest. Patient is supine on table. Examiner than takes leg closest to the patient’s hip onto the table and places the bent knee underneath the patient’s thigh. The patient will place one hand on the lateral side of the thigh and one hand on the medial side around the knee by the tibial tuberosity. Patient will then stabilize the thigh and then with hand by the knee the examiner will apply an upwards force to anteriorly stress the knee.
(+): soft mushy end feel and/or anterior translation of tibia 3 mm or greater than uninjured leg = Indicates ACL tear
(-): no soft mushy end feel and/or anterior translation of the tibia 3 mm or greater than the uninjured leg = Indicates no ACL tear
Purpose: ACL integrity
How to perform: Patient is supine on table with hip at 45 degree and knee at 90 degrees. Examiner site on side of table on top of the patient’s foot in neutral position. Examiner places hands around tibia and on the joint line. Examiner than draws the tibia forward on the femur.
(+): Excessive anterior translation of tibia noticed = Indicates sprained or torn ACL
(-): No Excessive anterior translation of the tibia noticed = Indicates the anterior translation of the tibia
Purpose: ACL integrity
How to perform: Patient is supine on table with legs extended. Examiner take one hand in a fist and places it underneath the middle of the calf muscle. The examiner will than take the other hand and push down on the quad muscles.
(+): Foot doesn’t move as quad is pressed down upon = Indicates ACL tear
(-): Foot moves as the quad is pressed down upon = Indicates no ACL tear
Purpose: ACL integrity
How to perform: Patient lies supine. Examiner supports test foot at the calcaneus and other hand at the height of the fibula. Examiner applies valgus force while putting patient in extension to flexion
(+): tibia jolts backward with being put in flexion, clunk sound, and/or patient feels knee give way = Indicated ACL tear
(-): The tibia doesn’t jolt backward with being put in flexion, clunk sound, and/or patient feels knee give way = Indicates no ACL
Purpose: PCL integrity
How to perform: Patient is supine on table with hip at 45 degree and knee at 90 degrees. Examiner site on side of table on top of the patient’s foot in neutral position. Examiner places hands around tibia and on the joint line. Examiner than draws the tibia posteriorly on the femur.
(+): excessive posterior translation of tibia = Indicates possible PCL tear (complete or partial)
(-): No excessive posterior translation of tibia = Indicates no PCL tear
Purpose: PCL integrity
How to perform: Patient is supine on table. Examiner takes ankles of patient and brings them together to lift the patient’s legs in the air. Till patient is at a 90/90 position, with 90 degrees of hip flexion and knee flexion. Examiner then holds the patient’s ankles in the air watching to see if a divot is created from hanging them.
(+): the tibia sink posteriorly creating a divot at the tibial tuberosity = Indicates possible PCL tear
(-): the tibia doesn’t sink posteriorly creating a divot at the tibial tuberosity = Indicates no possible PCL
Purpose: PCL integrity
How to perform: Patient is supine on table with knees at 45 degree angle with feet still on table. With both knees lined up, examiner than watches the tibial tuberosity of both legs to see if the tibia will sink posteriorly
(+): tibia sinks posteriorly creating a divot at the tibial tuberosity = Indicates possible PCL tear
(-): tibia sinks posteriorly creating a divot at the tibial tuberosity = Indicates no PCL tear
Purpose: PCL integrity
How to perform: Patient is supine on table with hip at 45 degree and knee at 90 degrees. Examiner site on side of table on top of the patient’s foot in neutral position. Examiner places hands around tibia and on the joint line. Examiner than instructs patient to push their foot into their body.
(+): tibia has a posterior sag and then would translate anteriorly once the pt’s quad is cx = Indicates possible PCL tear
(-): The tibia doesn’t have a posterior sag and doesn’t translate anterior once quad is cx = Indicates no tear to PCL
Purpose: capsule integrity
How to perform: Examiner has one had on the lateral side of the joint line and the other hand on the lateral side of the foot. Patient’s hip is flexed 45 degrees and leg. The knee is first flexed to 90 degrees, then extended maintaining medial rotation and valgus stress.
(+): big clunk is felt at 20-30 degrees of flexion and tibia shifts forward = Indicates capsule injury
(-): No big clunk is felt at 20-30 degrees of flexion and tibia shifts forward = Indicates no capsule injury
Purpose: Anterior Medial capsule/posterior lateral capsule integrity
How to perform: Patient is supine on table with hip at 45 degree and knee at 90 degrees. Examiner site on side of table on top of the patient’s foot in neutral position. Examiner places hands around tibia and on the joint line. The patient internal rotates the foot, then examiner pulls tibia anteriorly. This is done also with the foot external rotated to.
(+): excessive motion of the tibia when pulled forward in both positions = Indicates capsule injury of either the anterior medial capsule or posterior lateral capsule
(-): no excessive motion of tibia when pulled forward in both positions = No injury to anterior medial or posterior lateral capsule
Purpose: Posterior Lateral Capsule/Posterior Cruciate Ligament integrity
How to perform: Patient prone on table. Examiner holds both heels of the patient’s legs. The examiner bends the patient’s legs at 30 degrees and 90 degrees. At each point of the test, the examiner will external rotate the feet out seeing if there is a degree of difference between the two feet.
(+): difference of rotation of 10° compared bilaterally
At 30°, PLC injury
At 90°, PCL injury
At both, PCL and PLC is involved
(-): no difference of rotation of 10° bilaterally = Indicates no PCL or PLC injury
Purpose: Meniscus Injury
How to perform: Patient is prone on the table with the tested leg having the knee at 90 degrees of flexion. Examiner than takes heel of the hand to the calcaneus and presses the knee down to the table while rotating it internally and externally. The other hand is stabilizing the thigh.
(+): recreation of pain and/or decreased rotation = Indicates meniscus injury
(-): no recreation of pain and/or decreased rotation = Indicates no meniscus injury
Purpose: Ligament Injury
How to perform: Patient is prone on the table with the tested leg having the knee at 90 degrees of flexion. Examiner than takes one hand on the hamstring and the other hand wraps around the ankle to lift the leg up while rotating internally and externally.
(+): Recreation of pain and/or increased rotation = Indicates ligament injury
(-): no recreation of pain and/or increased rotation = indicates no ligament injury
Purpose: meniscus
How to perform: Patient lies supine. Examiner supports test foot at the calcaneus and other hand at the height of the fibula. Examiner applies valgus force while putting patient in 30 degrees of flexion to extension.
(+): recreation of pain and/or feeling of a catching or clicking = Indicates meniscus injury
(-): recreation of pain and/or feeling of catching or clicking = Indicates no meniscus injury
Purpose: meniscus
How to perform: Patient is instructed to squat to the ground and then try to waddle a few feet.
(+): recreation of pain When going into position and also doing the duck walk = Indicates meniscus injury
(-): no recreation of pain when going into position and also doing duck walk = Indicates no meniscus injury
Purpose: Meniscus
How to perform: Patient is supine on the table. The tested leg is then brought into hyper flexion with the examiner having one hand around the knee and the other hand around the ankle. Examiner than rotates the tibia internally and externally.
(+): Recreation of pain, catching or clicking felt as tibia is rotated = Indicates meniscus injury
(-): no recreation of pain catching or clicking felt as tibia is rotated = Indicates meniscus injury
Purpose: Meniscus
How to perform: Patient Is standing on the ground upright on 1 leg. The patient goes into 5 degrees of flexion in the knee and then rotates to both sides. The patient also does this with 20 degrees of flexion.
(+): recreation of pain along the medial or lateral joint line and/or sense of locking or catching of the knee = Indicates meniscus injury
(-): no recreation of pain along medial or lateral joint line and/or sense of locking of knee = Indicates no meniscus injury
Purpose: Tight IT Band
How to perform: Patient is side-lying on the table with hips stacked upon each other at the edge of the table. Patient’s legs are at 45 degrees of flexion. Examiner is at the patient’s back side with one hand on top of the hips and the other on the top leg’s ankle. The examiner than brings the top leg over edge of the table and instructs the patient to relax while the examiner supports the leg as it lowers.
(+): upper leg stays in the air and does not fall down to table = Indicates tight IT band
(-): upper leg lowers and falls down of the edge of the table = Indicates no tight IT band
Purpose: Tight IT Band
How to perform: Patient is side-lying on the table with hips stacked upon each other at the edge of the table. Patient’s legs are extended fully. Examiner is at the patient’s back side with one hand on top of the hips and the other under the knee. The examiner than brings the top leg over edge of the table and instructs the patient to relax while the examiner supports the leg as it lowers.
(+): upper leg stays in air and does not fall down to table = Indicates tight IT band
(-): upper leg lowers and falls down off the edge of the table when relaxed = Indicates no tight IT band
Purpose: IT Band Friction Syndrome
How to perform: Patient’s legs are hanging off the table. IT band is then pressed into the lateral joint line by the examiner. Patient is then instructed to flex and extend knee.
(+): recreation of pain and/or crepitus felt = Indicated iliotibial band friction syndrome
(-): no recreation of pain and/or crepitus felt = Indicates no IT band friction syndrome
Purpose: IT band friction syndrome
How to perform: Patient is standing on shoulder width apart on the ground. Examiner than pushes the IT band into the the lateral joint line. The patient will than attempt to do a squat while the IT band is pressed into the lateral joint line.
(+): recreation of pain and/or crepitus felt = Indicates IT band friction
(-): no recreation of pain and/or crepitus felt = Indicates no IT band friction
Purpose: Differentiate between edema vs effusion of the patella
How to perform: Patient’s leg is extended and relaxed on the table. Examiner takes hand and pushes down on the patella observing how it bounces back and where fluid pushes out after the patella bounces back.
(+): floating or bouncing of the patella or uneven escape of fluid from bouncing back = Indicates effusion
(-): no floating or bouncing of the patella or uneven escape of fluid from knee = Indicates no effusion
Purpose: Chromdromalacia
How to perform: Patient is on table with legs all the way on table straight. Examiner will then put the palm of their hand onto the patella with the patient relaxing and then apply downward pressure to the patella and then grind it across the patellar groove.
(+): recreation of pain as patella is moved = Indicates possible chondromalacia
(-): no recreation of pain as patella is moved = No chondromalacia
Purpose: Chondromalacia
How to perform: Patient is on table with legs all the way on table straight. Examiner will apply hard pressure to the supra patellar tendon. Patient is then instructed to contract quad and hold cx.
(+): Patient is unable to maintain or perform the contraction, recreation of pain with movement of patella = Indicates chondromalacia
(-): Patient is able to maintain or perform the contraction, recreation of pain with movement of patella = Indicates no chondromalacia
Purpose: patelar subluxation
How to perform: Patient supine on table with thigh on table and examiner holding leg in full extension off the table. Examiner translate patella laterally/medially with thumb and holds the patella laterally while examiner flexes knee to 90 degrees and then returns leg to extension
(+): signs of apprehension by patient, contraction of quadriceps = Indicates patellar subluxation
(-): no signs of apprehension by patient, contraction of quads = Indicates no patella subluxation
Purpose: patellar subluxation
How to perform: With the patient having their legs extended on the table. The examiner than applies a gentle varus force upon patella and the patient is instructed to construct the quad
(+): recreation of pain or uncomfortable feeling or even contraction of the quad = Indicates possible patellar subluxation
(-): no recreation of pain or uncomfortable feeling or even contraction of the quad = Indicates no patella subluxation