Knee Injuries
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History
Palpation
ROM - kinetic analysis
Tests
Muscle testing
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Biomechanics
Ligaments
Conditions/Treatment
Home Exercises
History of Symptoms
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Fall with joint compression
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Tearing type injury
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Overall weakness pattern
Injury to skin/ligaments/muscles/joint
Slow onset
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Repetitive stress
History of Symptoms
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Pain - constant or in a motion
Weakness - what motion
Numbness - nerve entrapment
Prior history
How it impacts their life
Palpation
ITB
Sections of the
vastus
Lateral collateral
ligament
Supra and
infra
patella
Patella
mobility
Heads of the
hamstrings
Junction of the
sartorius and
gracilis
Popliteus
Heads of the
gastrocnemius
Kinetic Analysis
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Observe alignment of knee
standing
Patient bends knee and
observe stabilization
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Pelvis, knee and ankle
Walking observe
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Degree of femur motion
Degree of lower leg extension
Tests
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Drawer test
Lachman test
Lat. Pivot shift
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Apprehension
Clarke’s sign
Dreyer’s sign
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Abduction stress
Adduction stress
Apley’s
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Bounce home
McMurray sign
Drawer Test
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Patient supine with knee
bent 90 degrees and thigh
bent 45 degrees
Pull tibia forward
Normal = 6 mm
Positive = excess motion
Injured ant. Cruciate or
posterior oblique ligament or
popliteus
Lachman test
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Patient supine with knee bent
30 degrees
Apply pressure to move the
tibia forward while stabilizing
the femur
Positive = soft or mushy end
feel
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Injured ant. cruciate or medial
collateral ligament or
posterolateral capsule or
posteromedial capsule or
posterior oblique ligament or
popliteus
Lateral pivot shift
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Patient supine with hip
flexed and medially rotated
20 degrees
Hold foot and bend knee 5
degrees
Apply valgus stress and
bend knee to 40 degrees
Positive - tibia shifts
posterior
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Injured ant. Cruciate or
posterolateral capsule or
popliteus or ITB
Apprehension test
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Patient supine or sitting
with quadriceps relaxed
Apply lateral pressure
against the patella
If patella is about to
dislocate, the quadriceps
will contract and patient
looks apprehensive.
Clarke’s Sign
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Patient supine with
knee extended
Grasp superior portion
of patella and press
inferior
Hold patella inferior as
patient contracts
quadriceps
Positive = pain
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Chondromalacia patella
Dreyer’s sign
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Patient cannot raise leg
Grasp above the patella
with both hands and
compress the quadriceps
Ask the patient to raise
the leg
Ability to raise the leg
indicates possible patella
fracture
Abduction stress
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Supine - knee extended one hand under the lower
tibia the other on the lateral
aspect of the knee
Raise leg 30 degrees and
apply pressure against
lower leg laterally opening
the medial side of the knee
Positive = medial pain medial collateral ligament
Adduction stress
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Supine - knee extended one hand under the lower
tibia the other on the medial
aspect of the knee
Raise leg 30 degrees and
apply pressure against
lower leg medially opening
the lateral side of the knee
Positive = lateral pain lateral collateral ligament
Apley’s
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Prone - knee bent 90 degrees
Strongly int. rotate tibia and
bend knee 90 deg.
Strongly ext. rotate tibia and
bend knee 90 deg. with
downward pressure
Hold femur on table and
distract tibia. Then rotate
internal and external
Positive = pain - meniscus tear
Bounce home
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Patient supine with
knee bent
Hold heel of foot and
let leg drop extending
knee
Positive = incomplete
extension or rubbery
end feel
McMurray Sign
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Patient supine - knee at 90
degrees
One hand on the knee the
other the ankle
Internally rotate the lower leg
and extend the knee with
valgus pressure
Repeat with external rotation
Positive = pain, snap or click
Muscle Testing
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Rectus Femoris
Vastus intermedius
Vastus lateralis
Vastus medialis
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Hamstrings medial
Hamstrings lateral
Popliteus
Gastrocnemius
Adductors
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Gluteus maximus
Gluteus medius