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Orthopaedics

Knee Examination

Knee Examination
Inspection
Palpation
Range of motion
Active and passive

Neurovascular Exam

Inspection
Skin
scars
trauma
erythema

Swelling
Muscle atrophy
normal quadriceps circumference
15 cm (quadriceps)

Asymmetry
Gait
antalgia
stride length
muscle weakness

Standing limb alignment


neutral, varus, valgus

Palpation
Joint line tenderness
Tenderness over soft tissue structures
pes anserine bursae
patellar tendon
iliotibial band

Point of maximal tenderness


Effusion
patella

Range of Motion
Active and passive
flexion/extension normal range
10 extension (recurvatum) to 130 flexion

rotation varies with flexion


in full extension, there is minimal rotation
at 90 flexion, 45 ER and 30 IR

abduction/adduction
in full extension, essentially 0
at 30 flexion, a few degrees of passive
motion possible

Neurovascular Exam
Sensation
medial thigh - obturator
anterior thigh - femoral
posterolateral calf - sciatic
dorsal foot - peroneal
plantar foot - tibial

Motor
thigh adduction - obturator
knee extension - femoral
knee flexion - sciatic
toe extension - peroneal
toe flexion - tibial

Vascular
pulses
popliteal
dorsalis pedis
posterior tibial

ankle-brachial index
ABI < 0.9 is abnormal

ACL Injury
Large hemarthrosis
Quadriceps avoidance gait (does not actively
extend knee)
Lachman's test
most sensitive exam test
grading

A= firm endpoint, B= no endpoint


Grade 1: <5 mm translation
Grade 2 A/B: 5-10mm translation
Grade 3 A/B: >10mm translation

PCL tear may give "false" Lachman due to


posterior subluxation

ACL Injury
https://youtu.be/xLKX6L2TXmA

PCL Tear
Posterior sag sign
patient lies supine with hips and knees flexed to 90,
examiner supports ankles and observes for a
posterior shift of the tibia as compared to the
uninvolved knee

Posterior drawer (at 90 flexion)


with the knee at 90 of flexion, a posteriorly directed
force is applied to the proximal tibia and posterior
tibial translation is quantified
the medial tibial plateau of a normal knee at rest is
~1 cm anterior to the medial femoral condyle
most accurate maneuver for diagnosing PCL injury

MCL Tear
Valgus instability = medial opening
30 only - isolated MCL
0 and 30 - combined MCL and ACL
and/or PCL
classification
Grade I: 0-5 mm opening
Grade II: 6-10 mm opening
Grade III: 11-15 mm opening

LCL Tear
Varus instability = lateral opening
30 only - isolated LCL
0 and 30 - combined LCL and ACL
and/or PCL
Varus opening and increased
external tibial rotatory instability at
30 - combined LCL and
posterolateral corner

Meniscus Injury
Joint line tenderness
Effusion
McMurray's test
flex the knee and place a hand on
medial side of knee, externally rotate
the leg and bring the knee into
extension
a palpable pop or click is a positive test
and can correlate with a medial
meniscus tear

Patellar Pathology
Large hemarthrosis
absence of swelling supports
ligamentous laxity and habitual
dislocation mechanism

Patellar Apprehension

Questions?