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The menisci are C-shaped discs of
fibrocartilage that are interposed between the
condyles of the femur and tibia.
Primary function is load transmission or
weight bearing.
Secondary function is shock absorption during
gait.
Contribute to joint stability and lubrication.
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Nerve endings provide proprioceptive
feedback for joint position.
A tear or loss of the menisci, either partial or
complete, hinders their ability to perform.
A twisting injury to the knee with the foot in
weight bearing can injure the menisci.
The outer 20% is vascular – peripheral injuries
may heal.
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Clinical Signs and Symptoms
Local medial or lateral joint pain
 Limited knee range of motion
 Crepitus upon movement
 Joint effusion
 Knee buckling
 Pain on walking up and down stairs
 Pain on squatting
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Procedure: Patient prone. Flex leg to 90
degrees. Grasp the patient’s ankle and apply
downward pressure while you internally and
externally rotate the leg.
Positive Test: Flexing the knee distorts the
meniscus. Downward pressure further stresses
the meniscus. Pain or crepitus on either side
indicates a meniscus injury on that side.
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Procedure: Patient supine. Flex leg.
Externally rotate the leg as you extend.
Internally rotate the leg as you extend.
Positive Test: Flexion and extension distort the
meniscus. Adding external and internal
rotation further distorts the meniscus. A
palpable or audible click indicates injury of the
meniscus.
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The major ligaments of the knee are the
anterior and posterior cruciate and the medial
and lateral collateral ligaments.
Ligament injuries are among the most serious
knee disorders.
Usually due to traumatic stress to the knee
while bearing weight.
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Valgus stress may sprain or tear the medial
collateral ligament.
Varus stress may sprain or tear the lateral
collateral ligament.
Both of these stresses with a rotational force
may sprain or tear the anterior and/or
posterior cruciate ligaments.
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Clinical Signs and Symptoms
Knee pain
 Limited range of motion
 Difficulty in weight bearing
 Joint effusion
 Knee giving out; chronic unstable knee
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Procedure: Patient supine. Flex the leg and
place the foot on the table. Grasp behind the
knee and pull and push on the leg. Hamstring
tendons must be relaxed.
Positive Test:
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More than 5 mm of tibial movement on the
femur when leg is pulled - injury or tear to one
or more of the following structures is indicated:
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Anterior cruciate ligament
Posterolateral capsule
Posteromedial capsule
Medial collateral ligament (more than 1cm movement)
Iliotibial band
Posterior oblique ligament
Arcuate-popliteus complex
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If excessive movement occurs when the leg is
pushed, an injury to one or more of the
following structures in indicated:
Posterior cruciate ligament
 Arcuate-popliteus complex
 Posterior oblique ligament
 Anterior cruciate ligament
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Procedure: Patient supine. Knee 30° flexion.
Grasp thigh with one hand to stabilize. Grasp
tibia with opposite hand and pull forward.
Positive Test: Softened feel or anterior
translation of the tibia suggests a possible tear
of:
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Anterior cruciate ligament
Posterior oblique ligament
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Procedure: Patient prone. Flex leg to 30°.
Stabilize posterior thigh with one hand. Push
tibia posterior with the other hand.
Positive Test: Posterior pressure on the tibia
stresses the posterior cruciate ligament. A soft
end feel and posterior translation of the tibia
are positive findings.
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Procedure: Patient prone. Flex leg to 90°.
Stabilize patient’s thigh with your knee. Pull
on the ankle while internally and externally
rotating the leg.
Positive Test: Distraction of the knee takes
pressure off the meniscus and puts strain on
the medial and lateral collateral ligaments
(non-specific).
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Procedure: Patient supine. Stabilize medial
thigh. Grasp lower leg and push medially.
Positive Test: Excessive movement of the tibia
away from the femur indicates a possible tear
of:
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Tibial collateral ligament
Posterior meniscofemoral ligament
Posterior medial capsule
Anterior cruciate ligament
Posterior cruciate ligament
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Procedure: Patient supine. Stabilize lateral
thigh. Grasp lower leg and pull it laterally.
Positive Test: Excessive movement of the tibia
away from the femur indicates a possible tear
of:
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Fibular collateral logaments
Posterolateral capsule
Posterior cruciate ligament
Anterior cruciate ligament
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Grade 0
Grade 1+
opening
Grade 2+
Grade 3+
opening
No joint Opening
Less than 0.5 cm joint
0.5 to 1.0 cm joint opening
More than 1cm joint
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The patella protects the anterior aspect of the
knee.
It acts as a fulcrum that increases the
mechanical advantage of the quadriceps.
The patella lies in the trochlear groove. With
normal flexion and extension it tracks smoothly
in the groove.
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Many causes of anterior knee pain involve
abnormal tracking of the patella or direct
trauma to the patella.
Patellofemoral injuries include fractures,
dislocations, malalignment syndrome,
chondromalacia patellae, and patellofemoral
arthritis.
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Clinical Signs and Symptoms
Anterior knee joint pain
 Knee joint effusion
 Popping sensation
 Joint crepitus
 Discomfort with stair climbing
 Knee buckling
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Procedure: Patient supine. Move patella
medially and laterally while pressing down.
Positive Test:
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Pain under the patella - chondromalacia patellae,
retropatellar arthritis, or a chondral fracture.
Pain on the patella – osteochondritis.
Pain over the patella – prepatellar bursitis.
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Procedure: Patient supine. Manually displace
the patella laterally.
Positive Test: A look of apprehension on the
patient’s face and a contraction of the
quadriceps muscle indicates a chronic tendency
to lateral patella dislocation. Pain is also
present with this test.
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Effusion in and around the knee may be caused
by trauma, infection, degenerative joint
disease, rheumatoid arthritis, gout, or
pseudogout.
The fluid may contain blood, fat, lymphocytes,
and crystals such as urate, pyrophosphate, and
oxalate.
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Clinical Signs and Symptoms
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Knee pain on walking
Anterior knee inflammation
Knee joint warmth to touch
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Procedure: With one hand, encircle and press
down on the superior aspect of the patella.
With the other hand, push the patella against
the femur with your finger.
Positive Test: If fluid is present in the knee, the
patella will elevate when pressure is applied.
When the patella is pushed down, it will strike
the femur with a tap.