Knee special tests
- Lachman test
- Patient supine with knee flexed to 20-30 degrees; stabilize the femur and passively translate the tibia anteriorly
- Tests the integrity of the anterior cruciate ligament
- Positive: excessive anterior translation on the tibia compared to the uninvolved limb
- Patient supine with knee flexed to 20-30 degrees; stabilize the femur and passively translate the tibia anteriorly
- Anterior drawer test
- Patient supine with hip flexed to 45 degrees and knee flexed to 90 degrees; therapist passively translates the tibia anteriorly
- Tests the integrity of the anterior cruciate ligament
- Positive: excessive anterior translation on the tibia compared to the uninvolved limb
- Patient supine with hip flexed to 45 degrees and knee flexed to 90 degrees; therapist passively translates the tibia anteriorly
- Posterior drawer test
- Patient in supine with hip flexed to 45 degrees and knee flexed to 90 degrees; therapist passively translates tibia posteriorly
- Tests the integrity of the posterior cruciate ligament
- Positive: excessive posterior translation on the tibia compared to the uninvolved limb
- Patient in supine with hip flexed to 45 degrees and knee flexed to 90 degrees; therapist passively translates tibia posteriorly
- Valgus stress test
- Patient supine with knee resting at the edge of the mat; therapist applies valgus stress to the knee with the knee flexed at 0 and 30 degrees
- Tests the integrity of the medial collateral ligament
- Positive: laxity and pain compared to the uninvolved side
- Patient supine with knee resting at the edge of the mat; therapist applies valgus stress to the knee with the knee flexed at 0 and 30 degrees
- Varus stress test
- Patient supine with knee resting at the edge of the mat; therapist applies varus stress to the knee with the knee flexed at 0 and 30 degrees
- Tests the integrity of the lateral collateral ligament
- Positive: laxity and pain compared to the uninvolved side
- Patient supine with knee resting at the edge of the mat; therapist applies varus stress to the knee with the knee flexed at 0 and 30 degrees
- Pivot shift test
- Patient supine with knee extended, hip flexed, and abducted to 30 degrees and slight internal rotation; therapist holding knee with one hand and the foot with the other applies valgus force through a flexed knee
- Tests the integrity of the anterior cruciate ligament
- Positive: tibia reduction during the test by the iliotibial band
- Patient supine with knee extended, hip flexed, and abducted to 30 degrees and slight internal rotation; therapist holding knee with one hand and the foot with the other applies valgus force through a flexed knee
- McMurray test
- Patient supine with knee maximally flexed; therapist passively internally rotates and extends the knee, then moves to externally rotating and extending the knee
- Test the lateral meniscus (internal rotation) and the medial meniscus (external rotation)
- Positive: reproduction of click, popping, or pain in the knee
- Patient supine with knee maximally flexed; therapist passively internally rotates and extends the knee, then moves to externally rotating and extending the knee
- Apley’s compression test
- Patient positioned prone with the knee flexed to 90 degrees. The therapist applies a downward compressive force through the heel while medially and laterally rotating the tibia.
- Tests the integrity of the menisci of the knee
- Positive: reproduction of pain
- Patient positioned prone with the knee flexed to 90 degrees. The therapist applies a downward compressive force through the heel while medially and laterally rotating the tibia.
- Thessaly test
- Patient standing on involved leg while holding therapist’s hands; patient rotates body and leg internally and externally with knee flexed to 5 degrees and then at 20 degrees
- Test the lateral meniscus (internal rotation) and the medial meniscus (external rotation)
- Positive: reproduction of click, popping, or pain in the knee
- Patient standing on involved leg while holding therapist’s hands; patient rotates body and leg internally and externally with knee flexed to 5 degrees and then at 20 degrees
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Patellofemoral instability
- Patient supine with knee flexed to 30 degrees and quadriceps relaxed; therapist passively translates the patella laterally
- Test for patellar instability
- Positive: patient expresses apprehension or contracts the quadriceps muscle to prevent patellar dislocation
- Patient supine with knee flexed to 30 degrees and quadriceps relaxed; therapist passively translates the patella laterally
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Noble compression test
- Patient supine with knee flexed to 90 degrees and hip flexion; therapist applies pressure 1-2cm proximal to the lateral femoral epicondyle; with pressure maintained, the patient’s knee is passively extended
- Tests the iliotibial band
- Positive: patient experiences pain over the lateral femoral condyle
- Patient supine with knee flexed to 90 degrees and hip flexion; therapist applies pressure 1-2cm proximal to the lateral femoral epicondyle; with pressure maintained, the patient’s knee is passively extended
- Ottawa knee rules
- Apply the Ottawa knee rules to:
- Rule out fracture after acute knee injury
- Refer for imaging with one or more positive answers
- A negative test result states there is an absence of fracture
- If the answer is yes to any of these questions, the finding is reported to the supervising PT, who determines whether imaging is needed to rule out a fracture
- Age 55 years or older
- Isolated patellar tenderness without bone tenderness
- Tenderness of the fibula head
- Inability to actively flex knee to 90 degrees
- Inability to bear weight immediately after injury
- Apply the Ottawa knee rules to: