Inspection | Examine for the alignment of the lower extremities (varus, valgus, knee recurvatum), ankle eversion and foot pronation, gait, SEADS. |
Palpation | Include important landmarks: patellofemoral joint, medial and lateral joint lines (especially posterior aspects), pes anserine bursa, distal iliotibial band and Gerdy tubercle (iliotibial band insertion). |
Range of motion testing 
| Check range of motion actively (patient performs) and passively (clinician performs), especially with flexion and extension of the knee normally 0–10 degrees of extension and 120–150 degrees of flexion. |
Knee strength testing | Test resisted knee extension and knee flexion strength manually. |
Ligament Stress Testing |
Lachman test 
| Performed with the patient lying supine, and the knee flexed to 20–30 degrees. The examiner grasps the distal femur from the lateral side, and the proximal tibia with the other hand on the medial side. With the knee in neutral position, stabilize the femur, and pull the tibia anteriorly using a similar force to lifting a 10- to 15-pound weight. Excessive anterior translation of the tibia compared with the other side indicates injury to the anterior cruciate ligament. |
Anterior drawer 
| Performed with the patient lying supine and the knee flexed to 90 degrees. The clinician stabilizes the patient’s foot by sitting on it and grasps the proximal tibia with both hands around the calf and pulls anteriorly. A positive test finds anterior cruciate ligament laxity compared with the unaffected side. |
Pivot shift  
| Used to determine the amount of rotational laxity of the knee. The patient is examined while lying supine with the knee in full extension. It is then slowly flexed while applying internal rotation and a valgus stress. The clinician feels for a subluxation at 20–40 degrees of knee flexion. The patient must remain very relaxed to have a positive test. |
Valgus stress 
| Performed with the patient supine. The clinician should stand on the outside of the patient’s knee. With one hand, the clinician should hold the ankle while the other hand is supporting the leg at the level of the knee joint. A valgus stress is applied at the ankle to determine pain and laxity of the medial collateral ligament. The test should be performed at both 30 degrees and 0 degrees of knee extension. |
Varus stress 
| The patient is again placed supine. For the right knee, the clinician should be standing on the right side of the patient. The left hand of the examiner should be holding the ankle while the right hand is supporting the lateral thigh. A varus stress is applied at the ankle to determine pain and laxity of the lateral collateral ligament. The test should be performed at both 30 degrees and 0 degrees of knee flexion. |
Meniscal Signs |
McMurray test | Performed with the patient lying supine. The clinician flexes the knee until the patient reports pain. For this test to be valid, it must be flexed pain-free beyond 90 degrees. The clinician externally rotates the patient’s foot and then extends the knee while palpating the medial knee for “click” in the medial compartment of the knee or pain reproducing pain from a meniscus injury. To test the lateral meniscus, the same maneuver is repeated while rotating the foot internally (53% sensitivity and 59–97% specificity). |
Modified McMurray  
| Performed with the hip flexed to 90 degrees. The knee is then flexed maximally with internal or external rotation of the lower leg. The knee can then be rotated with the lower leg in internal or external rotation to capture the torn meniscus underneath the condyles. A positive test is pain over the joint line while the knee is being flexed and internally or externally rotated. |
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Thessaly test 
| Performed with the patient standing on one leg with knee slightly flexed. The patient is asked to twist the knee while standing on one leg. Pain can be elicited during twisting motion. |