Knee Lab

resting position

30* flexion

closed pack

full extension

joint line tenderness

• meniscus lesion

• concordant pain provocation

• may be better for more peripheral lesion

tests for meniscus lesion

• JLT

• thessaly

• dynamic

• mcmurray

• appley

JLT LR

+ LR = 0.83-31.0

- LR = 0.12-0.76

thessaly test

• meniscus lesion

• pain reproduced

dynamic test

• lateral meniscus

• pain increases throughout hip motion

thessaly LR

+LR = 20* = 30.0 - 1.3, 5* = 6.8

-LR = 20* = .10-.73, 5*= 0.76

dynamic LR

+LR = 8.5

-LR = .17

mcmurray test

• meniscus

• audible thud/click

mcmurray LR

+LR = 8.0-1.6

-LR = 0.48 - 0.86

appley

• meniscus

• pain compression > distraction or pain with rotation greater than static w/ distraction

appley LR

+LR = 0.8 - 1.84

-LR = 0.33-1.1

ligament integrity tests

• lachmans

• pivot shift

• ant drawer

• post drawer

• varus and valgus stress

lachmans

• ACL integrity (gold standard)

• positive: translation on affected

pivot shift

• ACL integrity, rotary stability

• positive: audible, palpable thud or click

• better for confirming ACL tear

anterior drawer

• ACL integrity

• positive: translation affected side

• screen or confirm ACL tear

posterior drawer

• PCL integrity

• positive: excessive tibial translation

• screen or confirm

varus/valgus instability

• MCL/LCL integrity

• positive:

  • ACL/PCL implicated with laxity at full ext

  • MCL/LCL implicated with laxity at 30* flexion

• rule out or confirm

patellofemoral dysfunction tests

• patellar apprehension

• clarke’s

patellar apprehension

• positive: concordant pain, signs of apprehension

• better to confirm

clarkes sign

• PFPS

• symptom reproduction