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Examination of the Knee

  • Introduction
  • General comment
    • No evidence of systemic disease
  • Walking aids
  • Shoes
    • Off the shelf, commercial shoes with no modifications or insoles
    • Wear pattern

Patient Standing

Feet together & pointing straight ahead, medial foot boarders parallel

Anterior Aspect

  • If normal say
    • In the coronal plane the patient has normal anatomical limb alignment, symmetrical lower limbs with no atrophy & no evidence of surgical scars
  • Alignment
    • Standing limb Alignment
      • Physiological valgus alignment
        • 7° in women & 5° in men
    • Knees
      • genu valgum
      • genu varum
      • windswept deformity
    • Patellar
      • rotation
      • squinting patellae
    • Foot
      • rotation
      • symmetrical ER
  • Proximal to distal
    • skin changes
      • scars
        • well healed surgical incision
      • atrophic changes to the lower limb including
        • hair loss
        • venous hyperpigmentation
        • dry skin
      • varicosities
      • dekeratinisation
    • Muscles Wasting
        • Quads
    • Swellings about the knee
      • localized or generalized
    • Patella
      • Patellar Alignment
        • Gives indication of rotational malalignment in the limb
      • alta, baha
      • squinting
        • (point together, indicates excessive femoral anteversion, where compensatory tibial ER allows the feet to point forwards/primary tibial external torsion with hip IR)
      • out-facing
        • (habitual subluxation/dislocation, femoral retroversion)
      • prepatellar bursitis
      • patellar tendon
      • infrapatellar (Hoffa’s) fat pad, ganglion cysts
      • prominent tibial tuberosity (Osgood Schlatter)
      • Jumper’s knee (Sinding-Larsen-Johansson)

Turn the patient to the side

Please face the other wall sir

Please straighten your knee as much as possible
  • Describe position of
    • Spine
    • Pelvis
    • Hip
    • Knee
      • Fixed flexion / recurvatum
        • Causes
          • effusion
          • entrapped meniscus
          • ACL stump
          • loose body
    • Ankle
    • Feet
        • Equinus
  • Scars
    • Tibial osteotomy

Turn the patient away from you

Please face the back wall

  • Spine
    • Sagittal deformity
  • Pelvis
    • Level
  • Buttock folds
  • Quads wasting
  • Popliteal creases
  • Calf
  • Hindfoot alignment
  • Forefoot rotation

Gait

Next get the patient to walk & note gait

  • Anterior & Posterior Perspectives
    • Thrust
      • Valgus varus
    • Antalgic
    • Short leg
    • Foot progression
  • Lateral Perspective
    • recurvatum thrust
    • stiff knee gait
      • weak quads, pain in flexion
    • back knee gait
    • flexed knee gait
    • shorter stride length
    • 3 rockers
  • Options
    • Hop & turn
      • Tests stability
    • Squat
    • Duck-walking
      • Patients who can duck walk cannot have a serious meniscal injury