Knee Special Tests

what is the test procedure for a McMurray’s test

clinician maximally flexes and extremely rotates the knee (medial meniscus), Clinician maximally flexes and internally rotates the knee (lateral meniscus). Varus/valgus stress may be applied

what is a positive McMurray’s test

palpable or audible click or thud and/or isolated recreation of pain

what is a positive McMurray’s indicative of

a menisicus tear/injury

what is the test procedure for Apley’s compression/distraction test

clinician distracts and rotates the tibia internally/externally. Clinician then compresses the tibia and rotates internally/externally

what is a positive Apley’s compression/distraction

pain with compression: meniscus

pain with distraction: capsule/soft tissue

what is a positive Apley’s indicative of

a torn/injured meniscus

what is the test procedure for Steinmann sign

clinician grasps heel of tested limb with hand and places other hand on the anterior aspect of the knee, with thumb on the lateral joint line and middle finger on medial joint line. Clinician flexes the knee/hip to varying degrees, and rotates the knee without flexing or extending the knee

what is a positive steinmann sign

joint line pain or tenderness

what is a positive steinmann sign indicative of

a torn/injured meniscus

what is a priority cluster of meniscus tests

McMurray’s, Apley’s, Steinmann Sign

what is the clinical prediction rule for meniscus injury

history of catching/locking

joint line tenderness

pain with forced hyperextension

pain with maximal passive knee flexion

pain/audible click with McMurray’s maneuver

what is the test procedure for thessaly’s test

patient internally and externally rotates their knee and body three times

what is a positive thessaly’s test

discomfort or a sense of locking/catching in the knee along the joint line

what is a positive thessaly’s test indicative of

meniscus tear/injury

what is the test procedure for Ege’s test

Medial meniscus: patient externally rotates both lower extremities, then squats and stands up slowly

Lateral meniscus: patient internally rotates both lower extremities, then squats and stands up slowly

what is a positve Ege’s test

pain or click on joint line

what is a positive Ege’s test indicative of

meniscus injury/tear

what is the test procedure for dynamic knee test

clinician adducts the hip while maintaining 90 degrees of knee flexion

what is a positive dynamic knee test

sharp pain at end range of adduction or increase in joint line pain

what is a positive dynamic knee test indicative of

lateral meniscus tear/injury

what is the test procedure for a valgus stress test

clinician stabilizes lower leg and places testing hand on lateral aspect of the knee. Clinician applies a medial valgus force to knee in 0 deg of flexion and 30deg of flexion

what is a positive valgus stress test

pain at the MCL or increased laxity when compared bilaterally

what is a positive valgus test indicative of

a torn MCL

what is the test procedure for the varus stress test

clinician stabilizes lower leg and places testing hand on medial aspect of knee. Clinician applies a lateral varus forces to knee in 0deg of flexion and 30deg of flexion

what is a positive varus stress test

pain at the LCL or increased laxity when compared bilaterally

what is a positive varus stress test positive of

LCL tear/injury

what is a positive varus stress test at 30deg flexion indicative of

that it is an isolated LCL injury

what is the test procedure of the Lachman’s test

clinician supports/stabilizes the distal femur and grasps the proximal tibia. Clinician applies an anterior translation force to tibia

what is a positive lachman’s

increased translation of tibia and soft end feel compared bilaterally

what is a positive lachman’s indicative of

a torn ACL

what is the test procedure for an anterior drawer test

clinician grasps proximal tibia/lower leg and applies an anterior translation force to the tibia

what is a positive anterior drawer

increased translation of tibia and soft end feel compared bilaterall

what is a positive anterior drawer indicative of

a torn ACL

what is the test procedure for the pivot shift test

clinician flexes the knee to 20-30 degrees and places torque on the tibia while rotating internally with hand. Clinician then applies a valgus force to knee and flexes the knee. The clinician then returns the patient to starting position

what is a positive pivot shift test

anterior subluxation of lateral tibial plateau with flexion and reduction with extension

what is a postive pivot shift test indicative of

a torn ACL

what is the test procedure for the lever sign/lelli’s test

clinician places one fist under the calf on affected leg. Clinician then applies a posterior force to distal femur

what is a positive lever sign test

no lower leg/heel rise with application of posterior force

what is a positive lever sign indicative of

a torn ACL

what is the test procedure of a forced active buckling sign

Clinician flexes affected hip until ipsilateral knee is 20-30deg knee flexion. Clinician applies on internal rotation to leg at ankle, then applies mild valgus stress. Patient actively extends the knee joint

what is a positive forced active buckling sign

distinct anterior tibial subluxation, felt at the lateral side of the knee

what is a positive forced active buckling sign indicative of

a torn ACL

what is the test procedure for the poterior drawer

clinician grasps proximal tibia/lower leg and applies a posterior translation force to the tibia

what is a positive posterior drawer test

increased translation of tibia and soft end feel compared bilaterally

what is a positive posterior drawer test indicative of

torn/injured PCL

what is the test procedure of the reverse lachman’s test

clinician supports/stabilizes the distal femur and grasps the proximal tibia. Clinician applies a posterior translation force to the tibia

what is a positive reverse lachman’s test

increased translation of tibia and soft or absent end feel compared bilaterally

what is a positive reverse lachman’s test indicative of

a torn or injured PCL

what is the test procedure of the reverse pivot shift test

allow weight to extend the knee. the clinician applies an axial load to the knee and a valgus force is applied (causing flexion). Around 20 degrees, the lateral tibial plateau will move anteriorly with a jerk-like movement, reducing and neutrally rotating itself

what is a positive reverse pivot shift test

knee reduction and neutral rotation

what is another name for the reverse pivot shift test

the jerk test

what is the test procedure for the posterior sag (godfrey’s) test

clinician supports leg in the air at the ankle. Clinician observes the location of the tibial plateau relative to the femoral epicondyles

what is a positive posterior sag test

posterior sagging of the tibia

what is the test procedure for the quadriceps active drawer

clinician stabilizes foot and medial-lateral knee (do not support A-P direction). Ensure patient thigh is relaxed, then ask patient to slide their foot distally down the table

what is a positive quadriceps active drawer

anterior translation of the tibia due to quadriceps contraction

what is a positive quadriceps active drawer test indicative of

a torn or injured PCL

what is the test procedure for the crossover test

patient plants affected limb on ground, and crosses in front/behind with unaffected limb. clinician stabilizes affected limb and patient rotates as far as possible on affected limb

what is a positive crossover test

pain, instability, and/or apprehension

what is a positive crossover test indicative of

leg in front: anterolateral instability

leg in back: anteromedial instability

what is the test procedure for the slocum’s test

clinician grasps proximal tibia/lower leg and applies an anterior translation force to the tibia with 30 degrees of interal/external rotation

what is a positive slocum’s test

increased translation of tibia and soft end-feel compared bilaterally

what is a positive slocum’s with internal rotation indicative of

anterolateral instability

what is a positive slocum’s with external rotation indicative of

anteromedial instability

what is the test procedure for tibial internal rotation test

clinician grasps both feet and internally rotates the tibia on the femur bilaterally

what is a positive tibial internal rotation test

increased internal rotation of the tibia (>10deg) compared bilaterally

what is a positive tibial internal rotation test indicative of

anterolateral rotary instability

what is the test procedure for the dial test

clinician grasps both feet and externally rotates the tibia on the femur bilaterally

what is a positive dial test

increased external rotation of the tibia (>10deg) compared bilaterally

what is the test outcome for an isolated injury to the PLC for the dial test

more than 10deg of external rotation in the injured knee is present at 30deg of flexion, but not at 90deg of flexion

what is the outcome of instability of the PCL for the dial test

more than 10deg of external rotation in the injured knee is present at 90deg of flexion, but not at 30deg of flexion

what is the outcome for a combined injury with the dial test

more than 10deg of external rotation in the injured knee is present at 30deg and 90deg of flexion. this is an injury of the PCL and the PLC

what is the test procedure for the external rotation recurvatum test

clinician grasps medial foot/great toe and lifts patients leg off of the table

what is a positive external rotation recurvatum test

increased hyperextension, external rotation of femur, and varus alignment

what is the test procedure for the hughston posterolateral drawer test

clinician asks patient to rotate the foot of the affected leg outward (ER). The clinician grasps the proximal tibia and pushes backwards

what is a positive hughstons posterolateral drawer test

excess posterior laxity or tibial translation

what is the test procedure of a hughstons posteromedial drawer

clinician asks the patient to rotate the foot of the affected leg inward (IR), The clinicain grasps the proximal tibia and pushes backwards

what is a positive hughstons posteromedial drawer

excess posterior laxity or tibial translation

what is the test procedure for noble compression

clinician applies pressure on lateral aspect of distal thigh, over IT band. Clinician flexes knee to 30deg then extends knee

what is the test procedure for the renne test

clinician applies pressure on lateral aspect of distal thigh, over IT band. Patient does an active squat to 30deg, then stands

what is a positive noble compression/renne test

familiar or increased pain with knee at 30deg

what is a positive noble compression/renne test indicative of

IT band tightness/syndrome

what is the test procedure for the ober test

clinician abducts and extends affected leg behind unaffected leg, then allows the affected leg to adduct with gravity

what is a positive ober test

affected leg does not lower down to table

what is a positive ober test indicative of

tightness in the muscles that attach to the IT band

what is the test procedure for Wilson’s test

clinician grasps the patient’s foot and internally rotates the tibia. Patient then extends the knee until they feel pain

what is a positive Wilson’s test

recreation of symptoms/pain

what is a positive wilson’s test indicative of

osteochondritis dissecans/osteochondral defect or lesion