● Px position: Supine, knees in full extension
KNEE
● Modified hinge joint
● Susceptible to injury since it is NOT congruent
● Mainly dependent on ligaments and muscle
● Extra synovial in nature
○ Outside the synovium
WHEN TESTING FOR KNEES ALWAYS TEST BOTH
SIDES
MCL Sprains
Review of the MCL
● Taut all throughout the motions
● All fibers are taut during knee extension
● Ant. Fibers are most taut in flexion
● Post. Fibers are most taut midrange
● Restrains valgus rotation and lateral rotation of the
tibia
● Knee extension: Closed pack
● MCL will prevent lateral rotation
● Mechanism of Injury for MCL are usually a direct
blow to the lateral aspect of the knee creating a
valgus stress, disrupting the MCL
MCL Laxity Grading
Grade I Injury
● No increase in medial joint line opening compared
to the opposite knee at 30 degrees of knee flexion
and tenderness along the ligament (no movement)
● If you palpate the joint line in px with MCL, you will
feel that the tibia and femur are separating
Grade II Injury
● More generalized tenderness with 5 to 10 mm of
joint line opening on examination but a moderately
firm endpoint
Grade III Injury
● Complete disruption of the ligament and >10 mm
of joint line opening with only a vague endpoint, if
any
Clinical Assessment for MCL
Abduction/ Valgus Stress Test at 0°
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● PT position: apply a medial/ valgus stress at the
knee; stabilize the ankle in slight lat. Rot
Abduction/ Valgus Stress Test at 20-30° knee flexion
Hughston's Valgus Stress Test
● Px position: supine, knee at full extension
● PT position: faces the px, faces the px foot,
placing his or her body against the px thigh to help
stabilize the upper leg in combination with one
hand, which can also palpate the joint line. With
the other hand, the PT grasps the px big toe and
applies a vagus stress, allowing any natural
rotation of the tibia
● (+) sign = the tibia moves away from the femur an
excessive amount when a valgus stress is applied
LCL Sprain
Review of the LCL
● Taut in extension
● Loose in flexion, esp after 30 degrees flexion
(open pack/resting position)
● Restrains varus rotation (lateral gapping) and
lateral rotation
● Varus force from inside
● To palpate for the LCL - figure of 4; landmark is
lateral femoral condyle
● MOl for LCL usually occurs from high-energy
blow to the anteromedial knee, combining
hyperextension and extreme varus force
● Most commonly occurs in sports (40%) with high
velocity pivoting and jumping such as soccer
basketball, skiing, football or hockey
● Knee injuries are not isolated
Clinical Assessment for LCL
Adduction/ Varus Stress Test
● PT position: Applies a varus stress/
pushes the knee laterally at the knee
while the ankle is stabilized (push the
knee outward)
● Px position: supine, knee in full extension
then in
● 20-30 degrees flexion
Hughston's Varus Stress Test
 ● Same with hughston’s valgus but hand is on little
toe
● (+) sign = the tibia moves away from the femur
when a varus Stress is applied
ACL Sprain
Review Of the ACL
● Prevent anterior movement the tibia on the femur
(open)
● Prevents posterior movement/translation of femur
(CKC)
● Prevents medial rotation of the tibia
● Anteromedial bundle - taut in both flexion and
extension, limits ant translation and helps stabilize
medial and lateral rotation
● Posterolateral bundle - taut in low flexion angles
and med. rotation, limits ant. translation,
hyperextension and rotation.
● Least amount of stress between 30 to 60 degrees
flexion
● ACL is the most frequently injured ligament in the
knee mostly occurring in athletes
● The typical ACL injury occurs with the knee
externally rotated and in 10-30° of flexion when
the knee is placed in a vagus position as the
athlete takes off from the planted foot and
internally rotates with the aim of suddenly
changing direction
○ Ma bal-an mo nga ACL because it has
LOUD POPPING SOUND
Clinical Assessment for ACL
Anterior Drawer Sign
● Px position: supine, knee flexed to 90 degrees
with hip flexed to 45 degrees
● PT position: Stabilize px foot with body by sitting
on the forefoot with the foot in neutral rotation.
● Hands placed around the tibia to ensure hams are
relaxed. The tibia is then drawn forward on the
femur.
● (+) sign if > 6mm displacement (false positive =
injury to pcl)
● Always check for PCL injury FIRST
● Anterior drawer sign is NOT that reliable
Lachman Test
● Aka Ritchie, Trillat, Lachman-Trillat Test
● Best indicator of ACL injury with 77.7% sensitivity
and >95% specificity
○ Lachman > Ant. Drawer Test kay
ginakaptan gid mismo ang knee
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● Px position: Supine with involved leg beside PT
● PT position (1st Modification): hold px knee
between full extension and 30 degrees flexion.
Stabilize the femur in one hand while the proximal
aspect of the tibia is moved forward with the other
hand
● For best results, tibia should be slightly laterally
rotated and anterior tibial force should be applied
from the posteromedial aspect
● (+) sign = "mushy" or soft end feel during anterior
translation (easy movement; no restriction)
PCL SPRAIN
Review of the PCL
● Primary stabilizer of the knee against posterior
movement of the tibia on the femur
● Checks extension and hyperextension
● Maintains rotary stability and functions as knee's
central axis of rotation
● Fibers tight at 30 degrees flexion
● Not commonly injured
● MOI for PCL injuries are direct blow to the
proximal tibia, a fall on the knee with the foot in a
plantarflexed position, or with hyperflexion of the
knee
● Dashboard injuries - hyperflexion & posterior
displacement on the knees
● Injury of PCL in Sports: Proximal blow on the
front and the foot in PF
Clinical Assessment
Posterior Drawer Sign or Test
● Same instruction in the anterior drawer test but
the tibia is pushed back on the femur
● Perform posterior sag FIRST
● (+) sign = evident posterior sag (by gravity, the
knee it will post. translate
Posterior Sag Sign (Gravity Drawer Test)
● Px position: Supine, hip flexed to 45 degrees and
knee flexed to 90 degrees
● (+) sign = Sag sign
MENISCAL LESIONS
● Helps deepen the tibial plateau
● Has no vascular structures: no blood supply and
has no pain receptors
● Detected on chronic stage
● MRI
 ● (+) pain = Positive for medial meniscal lesions
● (+) click = Positive for lateral meniscal lesions
Signs and Symptoms of Meniscal Injuries
● med rot: testing for lat meniscus

● Bucket-handle tear (longitudinal)- MC

Thessaly Test (for chronic cases)
● Joint line pain
● Loss of flexion (more than 10°)
● Loss of extension (more than 5°) ● Active test
● Swelling (synovial) ● Px position: Stands flat footed on one leg; flex
● Crepitus knee to 5 degrees and rotate femur on tibia
● Positive special test medially and laterally three times while
maintaining flexed knee; repeat at 20 degrees
● PT position: provides hands for balance
Clinical Assessment for Meniscal Lesions
● Good leg first then bad leg
● (+) medial or lateral joint line discomfort = (+)
meniscus tear
Apley's Test (Collateral & Meniscal structures)

JOINT INJURIES
● Px position: Prone with knee flexed to 90 degrees
● PT position: Anchor the px thigh to the bed under
knee. Then distract the knee and then medially
PLICA
and laterally rotate the tibia Then repeat with
compression.
● (+) pain during rotation + distraction = ligamentous - Remnants for when we were fetuses (biological),
lesion ga dissolve man lang, but for others, naga persist
● (+) pain during lateral rotation + compression =
medial meniscal injury Knee Plica Injury
● (+) pain during medial rotation + compression =
lateral meniscal injury Hughston's Plica Test
● (+) decreased rotation relative to normal side = ● Px position: supine
meniscal injury ● PT position: passively flex knee and medially
● MENISCAL: compression first med, then lat rot rotate the tibia with one arm and hand while
pressing the patella medially with the heel of the
other hand and palpating the medial femoral
McMurray Test
condyle with the fingers of the same hand
● (+) "popping" of the plica under the fingers -
● Grandfather of Knee Meniscal tests positive test
● Low reliability & sensitivity (can yield false
positive)
Mediopatellar plica test
● Px position: supine with knee completely flexed
(heel to buttock)
● PT position: (for lateral meniscus) medially rotate ● Px position: supine with affected knee flexed to 30
the tibia and extend the knee (for medial degrees resting on a support
meniscus) laterally rotate tibia and extend. Ask px ● PT position: push the patella medially with the
to resist. thumb
● (+) snap or click with pain = (+) loose fragment of ● (+) pain or a click = (+) mediopatellar plica
the meniscus
TEST FOR SWELLING
Ege's Test
- Acute indication meniscal tear, ligamentous issues
● Active - Sometimes, sa OI ma bal an mo na nga ga swell,
● Px position: standing with knees in extension and but tests is for minimal effusion cases
both feet 11 to 15 in apart - Check first for signs of swelling using this test:
● (For medial meniscus) px laterally rotates each
tibia maximally and squats then stands slowly
Brush, Stroke and Bulge Test (aka Wipe or Brush
leaving the feet laterally rotated
Test)
● (For lateral meniscus) both tibias are medially
rotated maximally while the px squats and then
stands up
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 ● PT position: start just below the joint line on the
medial side of the patella, stroke proximally
toward the px hip as far as the suprapatellar
pouch 2 or 3x with the palm and fingers; with the
opposite hand, stroke the lateral side of the patella
● (+) wave of fluid passing to the medial side of the
joint and bulges just below the medial distal
portion of the patella=swelling (take up to 2secs
for swelling to appear
● Used in minimal effusion
Patellar Tap Test
1. Px position: long sitting or supine; knee extended
or flexed to discomfort
2. PT position: apply a slight tap or pressure over the
patella
3. (+) "dancing patella" sign - floating patella-
ballotable patella
4. If there is fluid in the knee = dancing patella
5. If there is separation of fingers bc nag hubag ang
knee,
PATELLOFEMORAL DYSFUNCTION
● Occurrs tam an ka dugay nga pungko esp for
geria px, also mag squat and dugang sila standing
● Pain during functional motion such as going up
the stairs, squats due to tight ITB or weak hip
abductors, prolonged sitting
● Tight ITB = can pull patella outward
● if dysfunction sa lateral side: bc it will pull patella
outwards
Active Patellar Grind Test
● Px position: sitting on bed/ table with knee flexed
at 90 degrees over the edge; actively extend the
knee
● PT position: feel the patella for crepitus
● (+) crepitus
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Clarke's Sign
● Assess articular surface of the patella
● Px position: supine, knee extended
● Ask px to isomet contract the quads
● PT position: press down slightly proximal to the
upper pole or base of the patella with the web of
the hand; then ask px to actively contract the
quads
● (-) clarke's sign - px can complete and maintain
quads contractions pain
● (+) clarke's sign - retropatellar pain and px cannot
hold contraction
- Test patella in diff degrees (0, 30, 60, 90)
McConnell Test for Chondromalacia Patella
(common in young boys)
● Px position: sitting with the femur laterally rotated;
performs isometric quadriceps contraction at 120,
90, 60, 30 and 0 degrees with each contraction
held for 10 seconds
● PT position: passively extend the knee if (+) pain;
support the leg and medially push and maintain
the patella while returning the knee to the painful
angle; ask px to perform isom quad cn
● (+) positive patellofemoral origin of
Chondromalacia patella = decrease in pain felt
OTHER TEST
Fairbank’s Apprehension Test
● Test for dislocation of the patella (common in lat.)
● Recreate the dislocation
● Px position: supine with quadriceps relaxed and
knee flexed to 30 degrees
● PT position: push patella laterally
● (+) px contracts quadriceps to bring the patella
back "into line". apprehensive look of patient (bc
you are repeat the MOI, look at the reac of px, or
they may actively contract the knee)
● Common direction for dislocation of patella:
LATERAL
○ Since muscles on the medial side are
stronger
○ Happens to px who already experienced
patellar dislocation (recurring)
○ Medial femoral condyle is big
○ MOI: Flexion and pivot
Measurement of Leg Length
● Q-Angle
 ● Px position: Supine with legs right angle to a line
joining the two ASIS
● PT position: With a tape measure, obtain the
distance from one ASIS to the lateral or medial
malleolus on that side
● N = difference of 1.0 to 1.5 cm between the two
sides (>1.5 functional- stretch lang structural:
anatomical problem
● Lateral malleolus - structural
● Medial malleolus - functional
○ Muscle tightness or imbalance
● LONGER LEG will have more problems since siya
ga WB

Noble Compression Test

Wilson Test

● Test for iliotibial band friction

● Osteochondritis dissecans
● Tight ITB = pulls patella outward
○ Affects the medial femoral condyle
● Px position: Supine
● Px position: sitting with knee flexed over bed/
● PT position: Flex the px knee to 90 degrees
table; actively extend the knee with the tibia
accompanied by hip flexion; apply pressure to the
medially rotated; stop at 30 degrees if pain
lateral femoral condyle, or 1 to 2 cm proximal to it
increase; then laterally rotate (to relieve pain)
with the thumb; maintain the pressure while
● (+) Positive test = pain disappears during lateral
passively extending the knee
rotation
● (+) Positive test - (+ Pain at approx. 30 degrees
● Classic indication for OCD of the medial femoral
flexion
condyle
● MEDIAL SIDE is always affected due to WB: v
(Quadriceps) or Patellofemoral angle important ang Q angle (the wider, more bug at sa
med side: OA affected med fem condyle)
● Tracing from ASIS towards the midpoint of the
patella (Dissect to R and L side)
● Measure shaft of the femur then measure the
angle produced = Q angle
● Female > Male
○ Since females have wider pelvis
● Angle between the rectus femoris and the patellar
tendon
- W angle can add patellofemoral stress syndrome
● Normal Values
○ Males = 13 degrees
○ Females = 18 degrees
○ <13 degrees - consider chondromalacia
patella or patella alta
○ >18 degrees - consider CMP. subluxed
patella, increased femoral anteversion,
genu valgum, lat displacement of the tibial
(Terrible) Unhappy Triad of O’Donoghue
tubercle increased lateral tibial torsion
● Injury to ACL, medial meniscus, MCL
● Measured radiographically or physically
● In sitting position, the Q-angle should be 0
degrees, the presence of a "bayonet sign"
indicate abnormal alignment of the quadriceps, ROTARY INSTABILITY
patellar tendon or tibial shaft
- Knee injuries are not isolated: other parts may
be injured
- if force is from angeromed aspext
structuresbthat will be aff is

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 posterolat(popliteus tendon LCL, post
curcuete lig, gastronemious
- blow from posteromed aspect:
compartmentbthat will receive is anterolat
compart(structures ACL(lat fubers) ITB
- DIFFICULT TO DETECT: but usually athletes
makita esp if biomechanics ya, may
descrpancy
Anteromedial Rotatory Instability
Dejour Test
● Px position: Supine
● PT position: hold the px leg with one arm against
the body and hand under the calf to lift the tibia
while applying valgus stress while the other hand
pushes the femur down; in extension, affected
knee will present with anteromedial subluxation;
then flex the knee
● (+) reduction in the tibial plateau = positive test
● If jolt is painful = medial meniscus is injured
● If jolt is not painful = posteromedial corner has
been injured
Slocum Test
● Px position: supine, knee flexed to 80 degrees
and hip flexed to 45 degrees with foot in 30
degrees medial rotation
● PT position: Sit on px forefoot and draw tibia
forward
● (+) Test = Movement occurs primarily on the
lateral side of the knee (Indicates Anterolateral
rotatory instability)
● Anteromedial: pull laterally
● ALRI may indicate injury to he ff structures:
○ ACL
○ Posterolateral capsule
○ Arcuate-Popliteus Complex (APC)
○ LCL
○ PCL
○ ITB
● Do not perform the second part of the test if px is
(+) for ALRI
Second part of Slocum Test (Lemaire's T drawer
Test)
● Px position: Same for knee and hip, foot is placed
in 15 degrees lateral rotation
● PT position: Sit on forefoot and draw tibia
anteriorly
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● (+) Test = movement occurs primarily on the
medial side of the knee (indicative of anteromedial
rotary instability)
● MCL
● Post. Oblique Ligament
● Posteromedial capsule
● ACL
● Lateral = anteromedial
● Medial = anterolateral
Anterolateral Rotary Stability
Jerk Test of Hughston
● Px position: Sitting with foot on floor in neutral
rotation with hip flexed in 45 degrees and knee
flexed in 90 degrees
● PT position: Ask px to isometrically contract the
quadriceps while the examiner stabilizes the foot;
extend the leg, maintaining medial rotation and a
valgus stress
● (+) test = At approx 20 to 30 degrees flexion, the
tibia shifts forward, causing a subluxation of the
lateral tibial plateau
Lateral Pivot Shift Maneuver (Test of Maclntosh)
● Primary test to assess ALRI
● Excellent test for ruptures (3rd degree sprains) of
the ACL
● Px position: supine, hip flexed and abducted to 30
degrees and relaxed in slight medial rotation
● PT position: holds patient's foot with one hand
while the other hand is placed at the knee, holding
the leg in slight medial rotation by placing the heel
of the hand behind the fibula and over the lateral
head of the gastrocnemius muscle with the tibia
medially rotated
● (+) Test = Tibia subluxates and reduces
● Affected structures:
○ ACL
○ Posterolateral capsule
○ Arcuate-popliteus complex
○ LCL
○ TB
Losee Test
● Px position: supine
● PT position: hold the px ankle and foot so that the
leg is laterally rotated; flex knee to 30 degrees and
ensure the hams are relaxed; other hand is
positioned so that the fingers lie over the patella
and the thumb is hooked behind the fibular head;
apply a valgus force; then extend knee
 ● (+) test = "clunk" forward before full extension
(means that the tibia subluxed anteriorly)
Posteromedial Rotatory Instability
Active Posterolateral
ER Recurvatum
Hughston's posteromedial and posterolateral
Drawer Sign
a. Distinct pop may indicate ACL(makita MRI
di sa xray; fractures xray) injury or toe
osteochondral fx
b. Pop on the lateral aspect may indicate
popliteus tendon snapping over the lateral
femoral inferoposterior tubercle
4. Did it happen during acceleration, deceleration
or constant speed?
a. Acceleration and twisting may involve
meniscus
b. Deceleration (involves a top) often involve
cruciate ligaments
c. Constant speed with cutting (abrupt stop)
may involve the ACL

● Px position: Supine with knee flexed to 80 to 90 5. Nature of pain

degrees and hip flexed to 45 degrees a. Aching pain may indicate degenerative
● PT position: medially rotates the px foot slightly changes
and sits to stabilize it then pushes the tibia b. Sharp "catching" pain may indicate
posteriorly mechanical problem
● (+) Test = tibia moves or rotates posteriorly on the c. Arthritic pain is associated with stiffness in
medial aspect the morning
d. Anterior knee pain may be due to
Indicates that the ff structures are injured: patellofemoral problems, bursa pathology
● PCL (bursa helps cushion the forces but
● Post. Oblique Ligament subjected to mechanical forces may lead
● MCL to swelling), fat pad pathology, tendinosis
● Semimembranosus or OSD(osgoods latter disease in tibial
● tendon tubercle)
● Posteromedial capsule e. Patellofemoral pain is usually insidious
● ACL and occurs spontaneously, often from
● Medial meniscus overuse
f. Pain at rest is not mechanical in origin
(Pain at rest - red flag; could be a
KNEE JOINT ASSESSMENT malignancy)
g. Pain during activity is seen in structural
abnormalities (subluxation, patellar
Patient History maltracking)
h. Pain after activity or with overuse
characterizes inflammatory do (synovial
Mechanism of injury plica irritation or early tendinosis or
paratenonitis that may lead to Jumper's
● Valgus force with or without rotation MCL knee or Sinding-Larsen-Johansson
● Hyperextension ACL syndrome)
● Flexion with posterior translation PCL i. Generalize knee pain is usually of
● Varus force LCL contusions or partial tears of muscles or
● Osgood-Schlatter disease affects tibial tubercle ligaments (blows)
apophysis (common for boys) j. Complex ligament disruptions or muscle
○ Injury to the tibial tubercle apophysis dysfunction is usually from instability
k. Pain in the knee on ankle movements
1. Previous Injuries may implicate the superior tibiofibular joint
a. Dislocations (does not contri to the movement of knee,
if ga sakit ano KUNO HUHU) (Knee pain
2. Functional capacity without movement, consider it to be
a. Can the patient ambulate? Run? problem within the Tibiofibular Joint)
b. W or w/o pain or difficulty
3. "Clicking" or "Popping" during the occurrence 6. Pain in relation to activity
of the injury a. Constant pain is usually indicative of
tumor
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 7. Does the knee give way?
a. “Halog”
b. Knee giving away us indicative of
instability, meniscal pathology, patellar
subluxation, undisplaced OCD,
Patellofemoral syndrome, plica or loose
body

8. Knee locking
a. Loose bodies may cause recurrent locking
b. Locking in the knee usually means the
knee cannot fully extend with flexion being
normal
c. Related to meniscal pathology
d. Spasm locking is related to hamstrings
muscle spasm

9. Grating or clicking during movement

a. Caused by degeneration or by one's
structure snapping over another

10. Swelling
a. Swelling with activity - instability
b. Tightness at rest - arthritic changes or
patellofemoral dysfunction
c. Swelling with pivoting or twisting -
meniscus problems or instability at the
tibiofemoral joint
d. Recurrent swelling caused by climbing or
descending slopes - patellofemoral
dysfunction
e. Synovial swelling occurs 8 to 24 hours
after the injury
f. Swelling caused by blood is immediately
(usually fracture or dislocation)
g. Localized swelling - inflamed bursa

11. Patient’s Gait

12. Shoes the patient wears
13. Observation
14. Alignment
15. Mga genu varum chuchuchu

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