What are (2) special tests for the ACL injury?
- Anterior draw.
- Lachman’s.
Describe how to conduct Anterior draw test.
Patient supine with their knee flexed to 90 degrees and their foot stabilised. The therapist firmly draws the tibia anteriorly and feels for a solid end feel.
What will a positive anterior draw test present as?
- Soft end feel.
- Increased anterior translation of tibia.
Describe how to conduct Lachman’s test.
- Patient is in supine lying position with the leg bent to 30° of flexion and slight external rotation (this position may be supported by the examiner’s knee under the patient’s knee).
- Grasp proximal knee and attempt to translate tibia anteriorly.
- Palpate joint line to assess translation.
What will a positive Lachman’s test present as?
- Soft or mushy end-feel.
- Anterior translation on the tested knee (is >3mm compared to the other knee).
What are (2) special tests for PCL injury?
- Posterior Draw Test.
- Posterior Sag.
Describe how to conduct Posterior Draw Test.
- Patient supine with their knee flexed to 90 degrees. The therapist firmly pushes the tibia posteriorly and feels for any movement.
- It can also be performed in 90 degrees of hip flexion with the patient’s foot resting on the therapist’s knee.
What will a positive posterior draw test present as?
- Soft end feel.
- Increased posterior translation of tibia or a visible sag.
Describe how to conduct Posterior Sag.
Patient supine with their knee flexed to 90 degrees. The therapist looks at the knee shape from the front and side and compares both knees.
What will a positive posterior sag present as?
A visible sag of the tibia showing it to be sitting more posteriorly than normal, compared to the other side.
Describe how to conduct Medial & Collateral ligament Tests.
- Patient supine, with hip + knee slightly flexed or knee straight
- Therapist places one hand at the outside of
the knee, acting as a pivot point, while the other hand is holding the foot - A valgus (lateral force testing MCL) or various (medial force testing LCL) force is applied to the knee
- Therapist feels joint line for movement.
What is being looked for in Medial & Collateral ligament Tests?
- Pain over the ligament.
- Soft end feel.
- Widening of the stressed joint line or abnormal or unusual joint laxity / gapping.
What do positive Medial & Collateral ligament Tests indicated at 30 degrees & 0 degrees?
+ve 30o and 0o = G3 rupture.
+ve 30o only = G1 or G2 tear.
What are the (2) meniscal tests?
- McMurray’s.
- Thessaly.
Describe how to conduct the Thessaly test (Meniscal test - Standing).
While standing get the patient to balance (with your support) while they single leg stand and twist their body and rotate their knee internally & externally.
What will a positive Thessaly test present as?
- Pain.
- Locking.
- Catching.
Describe how to conduct McMurray’s test (Meniscal test - Supine).
Lateral force:
- Fully flex their knee.
- Turn ankle in towards leg.
- Apply force at the knee laterally (from medial side).
- Guide them through extension and flexion whilst maintaining the force.
Medial force:
- Fully flex their knee.
- Turn ankle out (away from leg).
- Apply force at the knee medially (from lateral side).
- Guide them through extension and flexion whilst maintaining the force.
What will a positive McMurray’s test present as?
- Reproducing patient’s pain.
- Clicking.
- Locking.
How & what can you palpate on the knee to assess the meniscus?
Palpate medial & lateral joint line of knee.
(Best accuracy when combined with a positive sweep test).
What will a positive palpation of the knee to assess a damaged meniscus present as?
- Pain.
- Thickening felt along the joint line.
Describe how to conduct a Sweep test.
- Sweeping the back of the hand up the medial knee to empty the medial knee compartment.
- Sweep up the lateral knee and watch for any swelling moving over (to medial side of patella).
What does a sweep test test for?
- Intra-articular swelling.
- Can be highly indicative of ACL or meniscal injuries.
What are some examples of functional tests for the knee?
- Single leg squat.
- Single leg stand (Eyes open/closed).
- Triple hop.
