Special Techniques - Knee

Lachman Test

Place the knee in 15 degrees of flexion and external rotation. Grasp the distal femur on the lateral side with one hand and the proximal tibia on the medial side with the other. With the thumb of the tibial hand on the joint line, simultaneously pull the tibia forward and the femur back. Estimate the degree of forward excursion.

Bulge Sign (small)

Suspected Knee Effusion. is used to determine the presence of fluid in the knee joint. It is useful when only a little fluid is present in the joint. The suprapatellar bursa is first emptied of fluid by squeezing distally from about 15 cm above the patella.

Ballottement (large)

Suspected Knee Effusion. the examiner would apply downward pressure towards the foot with one hand, while pushing the patella backwards against the femur with one finger of the opposite hand.

Varus stress test

Suspected Knee Injury. To assess the integrity of the LCL. The patient's leg should be relaxed for this test. The examiner should passively bend the affected leg to about 30 degrees of flexion. While palpating the lateral joint line, the examiner should apply a varus force to the patient's knee. A positive test occurs when pain or excessive gapping occurs (some gapping is normal at 30 degrees). Be sure to not include rotation of the hip in your application of force. Next the examiner should repeat the test with the knee in neutral (0 degrees of flexion). A positive test occurs when pain or gapping is produced. There should be no gapping at 0 degrees.

Drawer Test

Suspected Knee Injury. is used in the initial clinical assessment of suspected rupture of the cruciate ligaments in the knee. if tibia pulled >2 cm from femur, ACL injury suspected. If tibia can be pushed posteriorly >2 cm PCL injury suspected.

McMurray's Test

Suspected Knee Injury. is used to detect a meniscus tear in the knee. The test is performed with the patient lying down flat and the examiner bending the knee. A test is considered positive when a click is felt over the meniscus as the knee is brought from full flexion (completely bent) to 90 degrees of flexion.

Valgus Stress test

Suspected knee injury. is a test for ligament damage. It involves placing the leg into extension, with one hand placed as a pivot on the knee. With the other hand placed upon the foot applying an abducting force, an attempt is then made to force the leg at the knee into valgus.

Knee Apley Test

the patient lies prone (face-down) on an examination table and flexes their knee to a ninety degree angle. The examiner then places his or her own knee across the posterior aspect of the patient's thigh. The tibia is then compressed onto the knee joint while being externally rotated. If this maneuver produces pain, this constitutes a "positive Apley test" and damage to the meniscus is likely.