Knee examination

Check distal neurovascular status

LOOK

• Whilst standing and walking
• Skin- scars, redness
• Muscle- wasting of quads ( compare diameter of thigh if quads wasted )
• Bone/joint- Effusion, Varus Valgus deformity( measure intermalleolar distance if valgus), Q angle
• Remember to look in popliteal fossa
• Knee & ankle postitions (hamstring tightness)
• Walking - look for varus thrust = collapse into more varus in stance loading (dynamic varus due to medial compartment OA or lateral lig. laxity)

FEEL

• Skin - Temperature, back of hand
• Muscle- Ask patient to contract quads
• Bone/joint- Effusion fluid displacement test, patellar tap test (may be negative if tense effusion)
• Synovial thickening
• Joint line tenderness (with knee bent)
  • Femoral condyles (with knee bent)
  • Patellar tendon
  • MCL,LCL
  • Under patellar facets
  • Popliteal swellings

MOVE

• Active then passive-

• Flexion (135 degrees normal)

• Extension

• Feel for crepitus

SPECIAL TESTS

Ligaments

MCL +LCL 

leg under arm, 2 hands, 10 degrees flexion to relax the posterior capsule (careful not to rotate knee)

MCL - valgus stress in extension & flexion. Opening in extension implies injury to the posterior oblique ligament (= combined ligamentous injury)

LCL - is only taut in full extension & lax in flexion