Knee lab

Question 1

Special tests for the knee

Answer 1

• Bounce home
• Patella ballottement test (AKA patella tap test)
• Patella mobility (Glide)
• Q-angle
• Fairbank’s Apprehension test
• Zohler & Clarke (Grind) test

Question 2

Special tests for ACL

Answer 2

• Anterior drawer
• Lachman’s
• Pivot shift

Question 3

Special tests for PCL

Answer 3

• Posterior lag sign
• Posterior drawer

Question 4

Special tests for meniscus

Answer 4

• McMurray
• Thessaly’s
• Apley’s

Question 5

Describe the bounce home test

Answer 5

• Test for meniscal tear
• Patient Supine: Holding the LE under the distal leg or foot
• Allow the involved knee to gradually “bounce” into full extension
• Positive: block of full extension and/or pain at end range extension
• Low clinical value possibly due to multiple false positives: muscle guarding & pain

Question 6

Describe the Patella ballottement test (AKA patella tap test)

Answer 6

• Test for knee effusion
• Clinician pushes the fluid to the knee
• Tap (thumb or fingers) on the patella pushing it posteriorly
• POS = floating patella that taps the femoral condyle

Question 7

Describe the posterior sag sign (Godfrey)

Answer 7

• Test for PCL
• Have pt supine with legs at 90-90
• Looks for dip where tibial tuberosity should be
• Ask for isometric hamstring contraction

Question 8

Describe Lachman’s test

Answer 8

• Similar position to anterior/posterior drawer test but knee is in more extension

Question 9

What is the advantage of a prone Lachman’s test

Answer 9

• Able to grasp a larger leg

Question 10

Describe a pivot shift test

Answer 10

• Lateral Pivot Shift Test: Begin in Extension & Grasp the Heel adding IR of the Tibia. With the proximal hand induce a valgus force while flexing the knee to 90; at around 30-40 degrees the shift should occur (Reduction of the Tibia). Flex & Extend knee multiple times.
• Reduction (L) above: Start in Full Flex to 90 and IR the Tibia – any reduction = the pivot shift
• Pivot Shift Subluxation (R) above: Begin in knee flexion and IR the Tibia; apply valgus stress with proximal hand and slowly extend the knee – near full Ext the tibia plateau will relocate

Question 11

Describe Thessaly test

Answer 11

• Test the uninvolved side 1st
• Begin at 5 degrees knee flexion, Rotate 3x IR & ER
• Repeat at 20 degree knee flexion
• The test is positive if there is a sense of locking, catching, or pain at either the medial or lateral joint line.

Question 12

Describe Apley’s test

Answer 12

• Prone & Flex knee to 90
• Distraction and Compression with rotation (Both IR and ER)
• Possibly useful for meniscus tear with compression

Question 13

Describe Renne test

Answer 13

• For ITB Friction
• Apply pressure along the lateral femoral condyle
• Patient stands on involved side and flexes and extends knee
• POS for pain or crepitus around 30 degrees knee flexion

Question 14

Lists the functional optimization tests for the knee

Answer 14

• Chair rise test: 5xSTS vs 30sec STS
• Bilateral squat till pain/unilateral squat till pain
• Step down test
• Y-Balance test
• Single leg hop (for distance)
• Triple hop (3 hops for distance)
• Vertical Jump
• Side to side hop test (5-6’ apart)

Question 15

Open/closed packed position for the tibiofemoral joint

Answer 15

• Open: 25º flexion
• Closed: extension + tibial ER

Question 16

Open/closed packed position for the hip joint

Answer 16

• Open: 30º flexion, 30º ABD, and slight ER
• Closed: max extension, IR + ABD

Question 17

Open/closed packed position for the talocural joint

Answer 17

• Open: 10º PF
• Closed: max DF

Question 18

Which patella glides help with flexion and extension

Answer 18

• Inferior glide = flexion
• Superior glide = extension

Question 19

What motion does an anterior tibial glide help with

Answer 19

• Extension