top of page

Knee Assessment

Updated: Jan 31


Special Tests for the Knee


Musculoskeletal knee pain is a significant problem and ‘Special clinical tests’ are often used to provide the diagnosis. A plethora of publications within the literature have investigated the diagnostic accuracy of these assessments, yet despite the wealth of research their diagnostic accuracy remains unclear.


Assessments


Effusion


  • Grade effusion using a visual 'bulge' sign

  • Grade effusion using a visual return of fluid following a sweep

  • Evidence suggests individual assessments have low validity

  • Diagnostic accuracy can be improved with experience

  • Combining tests can improve sensitivity



Anterior Cruciate Ligament - ACL Injury


  • Anterior Draw Test

  • Positive = Greater anterior Tibial translation compared to contralateral side

  • Lachman's Test

  • Positive = Greater anterior Tibial translation compared to contralateral side

  • Pivot Shift Test

  • Positive = Audible 'thud' or 'click'

  • This combination of ACL tests provides highly accurate system of ruling in and out ACL injury particularly in non-acute patients.



Posterior Cruciate Ligament - PCL Injury


  • Posterior Draw test

  • Positive = posterior motion / translation of Tibia

  • Grade 1= 0-5mm

  • Grade 2 = 6-10mm

  • Grade 3 = 11mm +

  • Posterior Sag sign

  • Positive = Posterior sagging of the Tibia secondary to gravitational pull

  • This combination of PCL tests provides high levels of specificity and sensitivity to rule in and out a PCL injury



Meniscal Injury


  • Joint Line Tenderness

  • Positive with reproduction of patients pain

  • End Range Flexion

  • Positive for pain or block preventing full flexion

  • McMurry's Test

  • Positive with pain &/or Audible 'Clunk / Click'

  • Full Squat (if able)

  • Positive for pain or block preventing full flexion

  • Duck Waddle (if able)

  • Positive for pain or block preventing full flexion

  • The diagnostic accuracy of meniscal testing is somewhat variable.

  • Combining patient history, physical findings and special tests seem to be the most sensible approach to diagnosis.



Medial Collateral Ligament - MCL Injury


  • Valgus Stress test

  • Positive when excessive medial joint line gapping is noted at approximately 30 degrees knee flexion

  • This assessment appears sensitive for ruling out an MCL injury when the test is negative



Lateral Collateral Ligament - LCL Injury


  • Varus Stress Test

  • Positive when excessive lateral joint line gapping is noted at approximately 30 degrees knee flexion

  • There is limited research available which evaluates the reliability of LCL assessment diagnostic accuracy



Patella Femoral Instability (Dislocation / Subluxation Risk)


  • Patella Apprehension Test

  • Positive when patient shows signs of apprehension / pain during lateral patella glide

  • A specific test which helps to rule in patellofemoral instability






Did you find Knee Special tests Useful?

  • YES

  • NO




 
 
bottom of page