Knee - Special Tests

Ottawa Knee Rules

1) Tenderness of the patella 2) Tenderness of fibular head 3) inability to actively flex knee to 90 degrees or grater 4) Inability to walk 4 steps right after injury or in ER

OA EULAR Criteria

1) Knee pain 2) Morning stiffness 3) Functional limitations 4) Crepitus within knee, especially that which causes discomfort 5) Restricted ROM 6) Boney growth or enlargement in the knee

Sweep Test

It involves sweeping fluid from the medial side of the knee towards the lateral side, assessing for swelling.

Ballotable Patella Test

A clinical test used to assess effusion in the knee joint by applying downward pressure on the patella and observing for a rebound or floating sensation, indicating the presence of excess fluid.

Anterior Drawer

Positive - Increased anterior translation (soft of no endpoint)

Indicative - ACL Sprain (anterior bundle) or complete rupture

Lachman’s Test

Positive - Increased anterior translation (soft or no endpoint)

Indicative - ACL Sprain (posterior bundle) or complete rupture

Posterior Drawer

Positive - Increased posterior translation (soft or no endpoint)

Indicative - PCL Sprain

Godfrey’s Test

Positive - Unilateral posterior displacement of tibia

Indicative - PCL Sprain

Valgus Stress Test

Positive - Pain or increased laxity (soft or no endpoint)

Indicative - MCL sprain, medial joint capsule, cruciate ligament compromise

Varus Stress Test

Positive - Pain or increased laxity (soft or no endpoint)

Indicative - LCL Sprain, lateral joint capsule, cruciate ligament compromise

Quadriceps Active Test

Positive - Anterior translation of tibia

Indicative - PCL Sprain

Slocum’s Test

Positive - increased anterior translation (soft or no endpoint)

Indicative - Anterior Lateral Instability = damage to ACL, anteriorlateral capsule, IT Band, Popliteus, posterior lateral complex, lateral meniscus

Anterior Medial Instability = damage to MCL, anteriomedial capsule, ACL, pes anserine, medial meniscus

Crossover Test

Positive - pain, instability or apprehension

Indicative - anterior lateral instability = lateral capsule damage

Anterior Medial Instability = medial capsule damage

Pivot Shift

Positive - tibia clunks back as the leg is flexed between 30-40 degrees

Indicative - ACL, anteriolateral capsule, LCL, lateral meniscus

Lever’s Sign

Positive - knee does not extend, foot doesn’t come off of table

Indicative - ACL tear

Jerk Test

Positive - tibia’s position on femur reduces as leg is flexed in range of 30-40 degrees knee flexion

Jerk Test (what it is)

Hip is flexed to 45 degrees, knee flexed to 90 degrees, valgus and internal rotation force as knee is extended

Reverse Pivot Shift

Positive - tibia clunks during extension

Indicative - posterior lateral corner damage

External Rotation Test (Dial Test)

Positive - external rotation of greater than 10 degrees compared to the other side

Indicative - 30 = posteriorlateral corner damage

30 & 90 = PCL & posteriorlateral corner damage

90 = PCL

External Rotation Recurvatum

Positive - difference in hyperextension, external femoral rotation, and varus alignment

Indicative - posteriolateral corner trauma, PCL sprain, posteriolateral rotatory instability

Hughston Posteriorlateral (posterior medial drawer)

Positive - increased external rotation of tibia (soft or no endpoint)

Indicative - posterior lateral instability = posterior lateral corner or PCL damage

posterior medial instability = PCL, MCL, posteriormedial capsule

McMurray’s Test

Positive - popping, clicking, locking and pain

Indicative - meniscal tear

McMurray’s Test (passes)

Pass 1 - tibia neutral

Pass 2 - tibia internally rotated

Pass 3 - tibia externally rotated

Apley’s Compression & Distraction

Positive - pain experienced during compression and relieved during distraction

Indicative - meniscal tear

Thessaly Test

Positive - Joint line pain, locking and catching

Indicative - meniscal tear

Wilson’s Test

Positive - pain with IR is relieved with ER

Indicative - OCD on Medial Femoral Condyle

Nobel’s Compression Test

Positive - pain under thumb (common at 30 degrees)

Indicative - IT band inflammation, bursitis or inflamed lateral femoral condyle

Ober’s Test

Positive - femur does not adduct past horizontal

Indicative - Tight IT band