Special Tests - Knee

TESTS FOR LIGAMENTOUS
INSTABILITY
ONE-PLANE MEDIAL INSTABILITY

Abduction (valgus stress) test
PROCEDURE
• examiner applies a valgus stress (pushes the knee
medially) at the knee while the ankle is stabilized
in slight lateral rotation either with the hand or
with the leg held between the examiner's arm
and trunk. The knee is first in full extension, and
then it is slightly flexed (20° to 30°) so that it is
"unlocked."
POSITIVE TEST
• the tibia moves away from the femur an excessive
amount

Hughston's valgus stress test
PROCEDURE
• examiner faces the patient's foot, placing his or her
body against the patient's thigh to help stabilize
the upper leg in combination with one hand, which
can also palpate the joint line. With the other
hand, the examiner grasps the patient's big toe
and applies a valgus stress, allowing any natural
rotation of the tibia
POSITIVE TEST
• the tibia moves away from the femur an excessive
amount

INSTABILITY
ONE-PLANE LATERAL INSTABILITY

Adduction (varus stress) test
PROCEDURE
• The examiner applies a varus stress (pushes the
knee laterally) at the knee while the ankle is
stabilized. The test is first done with the knee in
full extension and then with the knee in 20° to 30°
of flexion.
POSITIVE TEST
• the tibia moves away from the femur when a
varus stress is applied

Hughston's varus stress test
PROCEDURE
• The examiner grasps the fifth and fourth toes and
applies a varus stress to the knee in extension and
slightly (20° to 30°) flexed.
POSITIVE TEST
• the tibia moves away from the femur when a
varus stress is applied

INSTABILITY
ONE-PLANE ANTERIOR INSTABILITY

Lachman Test
PROCEDURE
• patient lies supine with the involved leg beside the
examiner. The examiner holds the patient's knee
between full extension and 30° of flexion. patient's
femur is stabilized with one of the examiner's hands
(the "outside" hand) while the proximal aspect of the
tibia is moved forward with the other ("inside") hand.
POSITIVE TEST
• "mushy" or soft end feel when the tibia is moved
forward on the femur
• disappearance of the infrapatellar tendon slope

Modification 1
PROCEDURE
• The patient is sitting with the leg over the edge of
the examining table. The examiner sits facing the
patient and supports the foot of the test leg on
the examiner's thigh so that the patient's knee is
flexed 30°. The examiner stabilizes the thigh with
one hand and pulls the tibia forward with the
other hand.
POSITIVE TEST
• Abnormal forward motion

Modification 2
Stable Lachman test
PROCEDURE
• The patient lies supine with the knee resting on
the examiner's knee. One of the examiner's hands
stabilizes the femur against the examiner's thigh,
and the other hand applies an anterior stress
POSITIVE TEST
• Abnormal forward motion of tibia

Modification 3
Drop leg Lachman test
PROCEDURE
• The patient lies supine, and the leg to be
examined is abducted off the side of the
examining table and the knee is flexed to 25°. One
of the examiner's hands stabilizes the femur
against the table while the patient's foot is held
between the examiner's knees. The examiner's
other hand is then free to apply the anterior
translation force

Modification 4
PROCEDURE
• patient lying supine while the examiner
stabilizes the foot between the examiner's
thorax and arm. Both hands are placed
around the tibia, the knee is flexed 20° to
30°, and an anterior drawer movement is
performed.

Modification 5
PROCEDURE
• patient to lie supine while the examiner
stands beside the leg to be tested with the
eyes level with the knee. The examiner
grasps the femur with one hand and the
tibia with the other hand. The tibia is pulled
forward
• abnormal motion is noted

Modification 6 – Prone Lachman Test
PROCEDURE
• the patient lies prone, and the examiner stabilizes
the foot between the examiner's thorax and arm
and places one hand around the tibia. The other
hand stabilizes the femur

Modification 7
Active (no touch) Lachman test
PROCEDURE
• patient lies supine with the knee over the
examiner's forearm so that the knee is flexed
approximately 30°. The patient is asked to actively
extend the knee, and the examiner watches for
anterior displacement of the tibia relative to the
unaffected side.

Modification 8
Maximum Quadriceps test
PROCEDURE
• The test may be carried out with the foot held
down on the table to increase the pull of the
quadriceps.

Drawer Sign
PROCEDURE
• patient's knee is flexed to 90°, and the hip is
flexed to 45°. The patient's foot is held on the
table by the examiner's body with the examiner
sitting on the patient's forefoot and the foot in
neutral rotation. The examiner's hands are placed
around the tibia to ensure that the hamstring
muscles are relaxed. The tibia is then drawn
forward on the femur.
POSITIVE TEST
• tibia moves forward more than 6mm on the
femur

Active Drawer Test
PROCEDURE
• patient is positioned as for the normal
drawer test. The examiner holds the
patient's foot down. The patient is asked to
try to straighten the leg, and the examiner
prevents the patient from doing so
(isometric test).
POSITIVE
• tibia to shift forward to its normal position
• (+) torn PCL

INSTABILITY
ONE-PLANE POSTERIOR INSTABILITY

ONE-PLANE POSTERIOR INSTABILITY
• Drawer Test
• Active Drawer Test

Posterior Sag Sign (Gravity Drawer
Test)
PROCEDURE
• The patient lies supine with the hip flexed to 45°
and the knee flexed to 90°.
POSITIVE TEST
• tibia "drops back," or sags back, on the femur
because of gravity if the posterior cruciate
ligament is torn

Reverse Lachman Test
PROCEDURE
• The patient lies prone with the knee flexed to 30°,
and the examiner grasps the tibia with one hand
while fixing the femur with the other hand. The
examiner ensures that the hamstring muscles are
relaxed. The examiner then pulls the tibia up
(posteriorly), noting the amount of movement
and the quality of the end feel
POSITIVE TEST
• Excessive posterior movement

Godfrey (Gravity) Test
PROCEDURE
• The patient lies supine, and the examiner holds
both legs while flexing the patient's hips and
knees to 90°.
POSITIVE TEST
• If there is posterior instability, a posterior sag of
the tibia is seen.

INSTABILITY
ONE-PLANE ANTEROMEDIAL
ROTARY INSTABILITY

Slocum test
PROCEDURE
• patient's knee is flexed to 80° or 90°, and the hip
is flexed to 45°. The foot is first placed in 30°
medial rotation. The examiner then sits on the
patient's forefoot to hold the foot in position and
draws the tibia forward.
POSITIVE TEST
• movement occurs primarily on the lateral side of
the knee

Lemaire's T drawer test
PROCEDURE
• second part of the Slocum test, the foot is placed
in 15° of lateral rotation, and the tibia is drawn
forward by the examiner.
POSITIVE TEST
• the movement occurs primarily on the medial side
of the knee.

Dejour test
PROCEDURE
• patient lies supine. The examiner holds the patient's
leg with one arm against the body and the hand
under the calf to lift the tibia while applying a valgus
stress. The other hand pushes the femur down.
POSITIVE TEST
• In extension, this action causes anteromedial
subluxation in the pathological knee. If the knee is
then flexed, the tibial plateau reduces suddenly,
indicating a positive test. If the jolt is painful, it
indicates that the medial meniscus has been injured.
If it is not painful, the posteromedial corner has been
injured.

INSTABILITY
ONE-PLANE ANTEROLATERAL
ROTARY INSTABILITY

ONE-PLANE ANTEROLATERAL ROTARY
INSTABILITY
• Slocum Test

Lateral Pivot Shift Maneuver (Test
of MacIntosh)
PROCEDURE
• The patient lies supine with the hip both flexed and
abducted 30° and relaxed in slight medial rotation
(20°). The examiner holds the 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, causing the tibia to subluxate
anteriorly as the knee is taken into extension
POSITIVE TEST
“giving way”

Active Pivot Shift Test
PROCEDURE
• patient sits with the foot on the floor in neutral
rotation and the knee flexed 80° to 90°. The
patient is asked to isometrically contract the
quadriceps while the examiner stabilizes the foot.
POSITIVE TEST
• anterolateral subluxation of the lateral tibial
plateau

Losee Test
PROCEDURE
• patient lies supine while relaxed. The examiner holds
the patient's ankle and foot so that the leg is laterally
rotated and braced against the examiner's abdomen.
The knee is then flexed to 30°, and the examiner
ensures that the hamstring muscles are relaxed
• valgus force is applied to the knee; the examiner uses
the abdomen as a fulcrum while extending the
patient's knee and applying forward pressure behind
the fibular head with the thumb.
POSITIVE TEST
• “clunk“ forward before extension

Jerk Test of Hughston
PROCEDURE
• similar to the pivot shift maneuver.
• patient's hip is flexed to 45°. With this test, the
knee is first flexed to 90°. The leg is then
extended, maintaining medial rotation and a
valgus stress
POSITIVE TEST
• subluxation of the lateral tibial plateau with a jerk
at approximately 20° to 30° of flexion

Slocum ALRI Test
PROCEDURE
• patient is in the side-lying position (approximately
30° from supine). The bottom leg is the
uninvolved leg. The knee of the uninvolved leg is
flexed to add stability. The foot of the involved leg
rests and is stabilized on the examining table with
the patient's foot in medial rotation and the knee
in extension and valgus. The examiner applies a
valgus stress to the knee while flexing the knee.
POSITIVE TEST
• subluxation of the knee reduces at between 25°
and 45° of flexion

Crossover Test of Arnold
PROCEDURE
• patient is asked to cross the uninvolved leg in
front of the involved leg. The examiner then
carefully steps on the patient's involved foot to
stabilize it and instructs the patient to rotate the
upper torso away from the injured leg
approximately 90° from the fixed foot. When this
position is achieved, the patient contracts the
quadriceps muscles
POSITIVE TEST
• Reproduction of symptoms similar to lateral pivot
shift test

Noyes Flexion-Rotation Drawer
TestPROCEDURE
• Patient lies supine, and the examiner holds the
patient's ankle between the examiner's trunk and
arm with the hands around the tibia. The
examiner flexes the patient's knee to 20° to 30°
while maintaining the tibia in neutral rotation.
The tibia is then pushed posteriorly, as in a
posterior drawer test
• POSITIVE TEST
• posterior movement reduces the subluxation of
the tibia

Lemaire's Jolt Test
PROCEDURE
• patient is in side lying position with the test leg
uppermost. For the test to work, the patient must
be relaxed. With one hand, the examiner medially
rotates the tibia by grasping the foot and medially
rotating it with the knee in extension. The back of
the other hand pushes lightly against the biceps
tendon and head of fibula while the hand on the
foot flexes and extends the knee
POSITIVE TEST
• at about 15° to 20° of flexion, a "jolt" occurs with
displacement of the tibia

Flexion-Extension Valgus Test
PROCEDURE
• patient lies supine, and the examiner holds the
patient's leg as in the Noyes test. The examiner
palpates the joint line with the thumb and fingers
of both hands, and a valgus stress and axial
compression are applied while the knee is flexed
and extended
POSITIVE TEST
• If the anterior cruciate ligament is torn, the
examiner feels the reduction and subluxation.

Nakajima Test
PROCEDURE
• patient lies supine, and the examiner stands on
the side of the test leg. The patient's foot is held
with one hand, which medially rotates the tibia.
The knee is flexed to 90°. The examiner's other
hand is placed over the lateral femoral condyle
with the thumb behind the head of the fibula
pushing it forward. The examiner slowly extends
the knee while pushing the head of the fibula
forward.
POSITIVE TEST
• subluxation

Martens Test
PROCEDURE
• patient and examiner are positioned as for the
Noyes test. The examiner grips the patient's leg
distal to the knee joint with one hand an pushes
The femur posteriorly with the other hand. A
valgus stress is applied to the knee as the knee is
flexed
POSITIVE TEST
• Tibia reduces

INSTABILITY
ONE-PLANE POSTEROMEDIAL
ROTARY INSTABILITY

Hughston's Posteromedial and
Posterolateral Drawer Sign
PROCEDURE
• patient lies supine with the knee flexed to 80° to
90° and the hip flexed to 45°. The examiner
medially rotates the patient's foot slightly and sits
on the foot to stabilize it. The examiner then
pushes the tibia posteriorly.
POSITIVE TEST
• tibia moves or rotates posteriorly on the medial
aspect an excessive amount relative to the normal
knee

Posteromedial Pivot Shift Test
PROCEDURE
• Passively flexes the knee more than 45° while
applying a varus stress, compression, and medial
rotation of the tibia
POSITIVE TEST
• movements cause subluxation of the medial tibial
plateau posteriorly
• examiner then takes the knee into extension. At
about 20° to 40° of flexion, the tibia shifts into the
reduced position

INSTABILITY
ONE-PLANE POSTEROLATERAL
ROTARY INSTABILITY

• Hughston's Posteromedial and
Posterolateral Drawer Sign.

Jakob Test (Reverse Pivot Shift
Maneuver)
PROCEDURE (Method 1)
• patient stands and leans against a wall with the
uninjured side adjacent to the wall and the body
weight distributed equally between the two feet.
The examiner's hands are placed above and below
the involved knee, and a valgus stress is exerted
while flexion of the patient's knee is initiated.
POSITIVE TEST
• jerk in the knee or the tibia shifts posteriorly and
the "giving way" phenomenon

Jakob Test (Reverse Pivot Shift
Maneuver)
PROCEDURE (Method 2)
• patient lies in supine with hamstrings relaxed. The
examiner faces the patient, lifts the patient's leg,
and supports the leg against the examiner's
pelvis. The examiner other hand supports the
lateral side of the calf with the palm on the
proximal fibula. The knee is flexed to 70° to 80° of
flexion, and the foot is laterally rotated, causing
the lateral tibial plateau to subluxate posteriorly.
The knee is taken into extension by its own weight
while the examiner leans on the foot to impart a
valgus stress to the knee through the leg

POSITIVE TEST
• At ~ 20° of flexion, the lateral tibial tubercle
shifts forward or anteriorly into the neutral
rotation and reduces the subluxation
• The leg is then flexed again, and the foot falls
back into lateral rotation and posterior
subluxation.

External Rotation Recurvatum
Test
PROCEDURE
• patient lies in the supine position with the lower
limbs relaxed. The examiner gently grasps the big toe
of each foot and lifts both feet off the examining
table. The patient is told to keep the quadriceps
muscles relaxed (i.e., it is a passive test). While
elevating the legs, the examiner watches the tibial
tuberosities.
POSITIVE TEST
• affected knee goes into relative hyperextension on
the lateral aspect due to the force of gravity, with the
tibia and tibial tuberosity rotating laterally. The
affected knee has the appearance of a relative genu
varum.

Active Posterolateral Drawer Sign
PROCEDURE
• The patient sits with the foot on the floor in
neutral rotation. The knee is flexed to 80° to 90°.
The patient is asked to isometrically contract the
hamstrings, primarily the lateral one (biceps
femoris), while the examiner stabilizes the foot.
POSITIVE TEST
• posterior subluxation of the lateral tibial plateau

Standing Apprehension Test
PROCEDURE
• The patient stands on the affected knee. The
examiner then pushes anteriorly and medially on
the anterolateral part of the lateral femoral
condyle crossing the joint line. The patient is
then asked to slightly flex the knee while the
examiner pushes with the thumb.
POSITIVE TEST
Condylar movement and a giving way sensation

McMurray test
PROCEDURE
• The patient lies in the supine position with the
knee completely flexed (the heel to the buttock).
The examiner then medially rotates the tibia and
extends the knee. To test the medial meniscus,
the examiner performs the same procedure with
the knee laterally rotated.
POSITIVE TEST
• (+) snap or click that is often accompanied by pain

Apley’s test
PROCEDURE
• The patient lies in the prone position with the
knee flexed to 90°, thigh stabilized on table with
the examiner’s knee. The examiner medially and
laterally rotates the tibia, combined first with
distraction, then compression.
POSITIVE TEST
• (+)rotation plus distraction is more painful or
increased rotation, ligamentous
• (+)rotation plus compression is more painful or
shows decreased rotation, meniscus

“Bounce Home” test
PROCEDURE
• The patient lies in the supine position, and the
heel of the patient's foot is cupped in the
examiner's hand. The patient's knee is completely
flexed, and the knee is passively allowed to
extend.
POSITIVE TEST
• extension is not complete or has a rubbery end
feel ("springy block"),

Thessaly test
PROCEDURE
• The patient stands flat footed on one leg while
the examiner provides his/her hands for balance.
Pt flexes knee to 20 and rotates the femur on
the tibia medially and laterally three times while
maintaining the 20 flexion. Test first the good leg
and then the injured leg.
POSITIVE TEST
• Medial or lateral joint line discomfort
• Sense of locking or catching in the knee

O’Donohue’s test
PROCEDURE
• The patient is asked to lie in the supine position.
The examiner flexes the knee to 90°, rotates it
medially and laterally twice, and then fully flexes
and rotates it both ways again.
POSITIVE TEST
• increased pain on rotation in either or both
positions and is indicative of capsular irritation or
a meniscus tear.

Modified Helfet Test
PROCEDURE
• In the normal knee, the tibial tuberosity is in line
with the midline of the patella when the knee is
flexed to 90°. When the knee is extended, however,
the tibial tubercle is in line with the lateral border of
the patella
POSITIVE TEST
• If this change does not occur with the change in
movement
• (+)meniscal injury, possible cruciate injury, or
quadriceps have insufficient strength to “screw
home” the knee

Test for Retreating or Retracting
MeniscusPROCEDURE
• patient sits on the edge of the examining table or
lies in the supine position with the knee flexed to
90°. The examiner places one finger over the joint
line of the patient's knee anterior to the MCL,
where the curved margin of the medial femoral
condyle approaches the tibial tuberosity. The
patient's leg and foot are then passively laterally
rotated, and the meniscus normally disappears.
• The leg is medially and laterally rotated several
times, with the meniscus appearing and
disappearing

POSITIVE TEST
• meniscus does not appear
• the meniscus can be felt pushing against the
finger on medial rotation, and it disappears on
lateral rotation

Steinman's Tenderness Displacement
TestPROCEDURE
• The Steinman's sign is indicated by point
tenderness and pain on the joint line that
appears to move anteriorly when the knee is
extended and moves posteriorly when the knee is
flexed.
POSITIVE TEST
• Medial pain is elicited on lateral rotation
• lateral pain is elicited on medial rotation

Payr's Test
PROCEDURE
• The patient lies supine with the test leg in the
figure-four position
POSITIVE TEST
• pain is elicited on the medial joint line
• (+)meniscus lesion, primarily middle and
posterior part

Bohler's Sign
PROCEDURE
• patient lies in the supine position, and the
examiner applies varus and valgus stresses
to the knee
POSITIVE TEST
• Pain in the opposite joint line (valgus stress
for lateral meniscus

Bragard's Sign
PROCEDURE
• patient lies supine and the examiner flexes
the patient's knee. The examiner then
laterally rotates the tibia and extends the
knee
POSITIVE TEST
• Pain and tenderness on the medial joint line
• If the examiner then medially rotates the
tibia and flexes the knee, the pain and
tenderness will decrease.

Kromer's Sign
PROCEDURE
• This test is similar to Bohler's sign except
that the knee is flexed and extended while
the varus and valgus stresses are applied
POSITIVE TEST
• the same pain on the opposite joint line

Childress' Sign
PROCEDURE
• The patient squats and performs a "duck
waddle."
POSITIVE TEST
• Pain, snapping, or a click for posterior horn
lesion of the meniscus

Anderson Medial-lateral Grind Test
PROCEDURE
• The patient lies supine. The examiner holds the
test leg between the trunk and the arm while
the index finger and thumb of the opposite
hand are placed over the anterior joint line. A
valgus stress is applied to the knee as it is
passively flexed to 45°; then, a varus stress is
applied to the knee as it is passively extended,
producing a circular motion to the knee. The
motion is repeated, increasing the varus and
valgus stresses with each rotation
POSITIVE TEST
• Distinct grinding

Passler Rotational Grind Test
PROCEDURE
• The patient sits with the test knee extended and
held at the ankle between the examiner's legs
proximal to the examiner's knees. The examiner
places both thumbs over the medial joint line
and moves the knee in a circular fashion,
medially and laterally rotating the tibia while
the knee is rotated through various flexion
angles. Simultaneously, the examiner applies a
varus or a valgus stress
POSITIVE TEST
• Pain elicited on the joint line

Cabot’s Popliteal Sign
PROCEDURE
• The patient lies supine, and the examiner
positions the test leg in the figure four position.
The examiner palpates the joint line with the
thumb and forefinger of one hand and places
the other hand proximal to the ankle of the test
leg. The patient is asked to isometrically
straighten the knee while the examiner resists
the movement
POSITIVE TEST
• Pain on the joint

Mediopatellar Plica Test (Mital-
Hayden Test)
PROCEDURE
examiner flexes the affected knee to 30° resting
on a support or the examiner’s arm. Examiner
pushes the patella medially with the thumb.
POSITIVE TEST
• (+)pain or click

Plica "Stutter" Test
PROCEDURE
• The patient is seated on the edge of the examining
table with both knees flexed to 90°. The examiner
places a finger over one patella to palpate during
movement. The patient is then instructed to
slowly extend the knee.
POSITIVE TEST
• patella stutters or jumps somewhere between 60°
and 45° of flexion (0° being straight leg) during an
otherwise smooth movement. The test is effective
only if there is no joint swelling.

Hughston's Plica Test
PROCEDURE
examiner flexes the knee and medially rotates the
tibia with one arm and hand while pressing the
patella medially with the heel of the other hand
and palpating the medial femoral condyle with
the fingers of the same hand. The patient's knee is
passively flexed and extended
POSITIVE TEST
• "popping" of the plical band under the fingers

Patellar Bowstring Test
PROCEDURE
• The patient in sidelying position with the test leg
uppermost. Using the heel of one hand, the
examiner pushes the patella medially and holds it
there. The examiner then flexes the patient’s knee
and medially rotates the tibia with the other
hand. The patient’s knee is then extended.
POSITIVE TEST
• Examiner feels any sounds

Brush, Stroke, or Bulge Test (Wipe test)
PROCEDURE
• Examiner commences just below the joint line on
the medial side of the patella, stroking proximally
toward the patient's hip as far as the
suprapatellar pouch two or three times with the
palm and fingers. With the opposite hand, the
examiner strokes down the lateral side of the
patella

POSITIVE TEST
• A wave of fluid passes to the medial side of
the joint and bulges just below the medial
distal portion or border of the patella. The
wave of fluid may take up to 2 seconds to
appear.
• test shows as little as 4 to 8 mL of extra fluid
(normal is 1-7 mL)

Indentation Test
PROCEDURE
• The patient lies supine. The examiner passively
flexes the good leg, noting an indentation on the
lateral side of the patellar tendon. The good knee
is fully flexed, and the indentation remains. The
injured knee is then slowly flexed while the
examiner watches for the disappearance of the
indentation. At that point, knee flexion is stopped
POSITIVE TEST
• disappearance of the indentation. The greater the
swelling, the sooner the indentation disappears

Peripatellar Swelling Test
PROCEDURE
• The patient lies supine with the knee extended.
The examiner carefully milks fluid from the
suprapatellar pouch distally. With the opposite
hand, the examiner palpates adjacent to the
patellar tendon (usually on the medial side) for
fluid accumulation or a wave of fluid passing under
the fingers. examiner strokes the fluid into the
suprapatellar pouch. With one hand, the examiner
then squeezes or pushes down on the suprapatellar
pouch while watching the hollows on each side of
the patella for a wave of fluid to pass
POSITIVE TEST
Palpable fluid wave

Fluctuation Test
PROCEDURE
• The examiner places the palm one hand over
the suprapatellar pouch and the palm the other
hand anterior to the joint with the thumb and
index finger just beyond the margins of the
patella . By pressing down with one hand an
then the other
POSITIVE TEST
the examiner may feel the synovial fluid fluctuate
under the hands and move from one hand to the
other, indicating significant effusion.

Patellar Tap Test ("Ballotable Patella")
PROCEDURE
• With the patient's knee extended or flexed to
discomfort, the examiner applies a slight tap or
pressure over the patella
POSITIVE TEST
• floating of the patella should be felt. This is
sometimes called the "dancing patella" sign

Vastus Medialis Coordination Test
PROCEDURE
• The patient lies supine while the examiner
places a fist under the patient's knee. The
patient is asked to slowly extend the knee
without pressing into the examiner's fist or
lifting the leg away from the fist while trying to
achieve full extension.
POSITIVE TEST
• the patient cannot fully extend the knee or has
difficulty achieving full extension smoothly or
tries to use the hip flexors or extensors to
accomplish the task.

Clarke's Sign (Patellar Grind Test)
PROCEDURE
• The examiner presses down slightly proximal to
the upper pole or base of the patella with the web
of the hand as the patient lies relaxed with the
knee extended. The patient is then asked to
contract the quadriceps muscles while the
examiner pushes down.
• To test different parts of the patella, the knee
should be tested in 30°, 60°, and 90° of flexion as
well as in full extension.

POSITIVE TEST
• (+)retropatellar pain and the patient
• cannot hold a contraction

McConnell Test for Chondromalacia
Patellae
PROCEDURE
• The patient is sitting with the femur laterally rotated. The
patient performs isometric quadriceps contractions at 120°,
90°, 60°, 30°, and 0°, with each contraction held for 10
seconds. If pain is produced during any of the contractions,
the patient's leg is passively returned to full extension by
the examiner. The patient's leg is then fully supported on
the examiner's knee, and the examiner pushes the patella
medially. The medial glide is maintained while the knee is
returned to the painful angle, and the patient performs an
isometric contraction, again with the patella held medially.
POSITIVE TEST
• pain is decreased

Active Patellar Grind Test
PROCEDURE
• The patient sits on the examining table with the
knee flexed 90° over the edge of the table.
While the patient slowly straightens the knee,
the examiner places a hand over the patella to
feel for crepitus. Where in the ROM that pain
occurs will give an indication of what part of the
patella is demonstrating pathology. Greater
force can be applied through the patella by
asking the patient to step up and step down on
a small stool
POSITIVE TEST
• Crepitus and pain (step up-step down test)

Step Up Test
PROCEDURE
• The patient stands beside a stool that is 25 cm
(10 inches) high. The examiner asks the patient
to step up sideways onto the stool using the
good leg. The test is repeated with the other
leg.
POSITIVE TEST
Normally, the patient should have no difficulty
doing the test and have no pain. Inability to do
the test may indicate patellofemoral arthralgia,
weak quadriceps, or an inability to stabilize the
pelvis

Eccentric Step Test
PROCEDURE
• The patient stands on a 15-cm (6 inch )-high
step or stool while keeping the hands on the
hips. The patient steps down, first leading
with the injured leg (this tests the good leg
first) as slowly and smoothly as he or she
can.
POSITIVE TEST
The test is considered positive if pain is felt by
the patient

Waldron Test
PROCEDURE
• The examiner palpates the patella while the patient
performs several slow deep knee bends (these may
be unilateral squats or bilateral for easier
comparison. As the patient goes through the ROM,
the examiner should note the amount of crepitus
(significant only if accompanied by pain), where it
occurs in the ROM, the amount of pain, and
whether there is "catching" or poor tracking of the
patella throughout the movement.
POSITIVE TEST
• pain and crepitus occur together during the
movement

Passive Patellar Tilt Test
PROCEDURE
• The patient lies supine with the knee extended
and the quadriceps relaxed. The examiner
stands at the end of the examining table and
lifts the lateral edge of the patella away from
the lateral femoral condyle.
POSITIVE TEST
The patella should not be pushed medially or
laterally but rather should remain in the femoral
trochlea. The normal angle is 15°, although males
may have an angle 5° less than that of females.
Patients with angles less than this are prone to
patellofemoral syndrome

Lateral Pull Test
PROCEDURE
• The patient lies supine with the leg extended.
The patient contracts the quadriceps while the
examiner watches the movement of the patella.
Normally, the patella moves superiorly, or
superiorly and laterally in equal proportions.
POSITIVE TEST
If lateral movement is excessive, the test is
positive for lateral overpull of the quadriceps,
resulting in a patellofemoral arthralgia.

Zohler’s Sign
PROCEDURE
• The patient lies supine with the knees
extended. The examiner pulls the patella
distally and holds it in this position. The
patient is asked to contract the quadriceps
POSITIVE TEST
• Pain is indicative for chondromalacia
patellae

Frund’s Sign
PROCEDURE
• The patient is in the sitting position.
• The examiner percusses the patella in
various positions of knee flexion.
POSITIVE TEST
• Pain may signify chondromalacia patellae

Q-Angle or Patellofemoral Angle
PROCEDURE
• A line is then drawn from the ASIS to the midpoint
of the patella on the same side and from the tibial
tubercle to the midpoint of the patella. Normally,
the Q-angle is 13° for males and 18° for females
when the knee is straight.

POSITIVE TEST
• Any angle less than 13° may be associated with
chondromalacia patellae or patella alta. An
angle greater than 18°
• is often associated with chondromalacia
patellae, subluxing patella, increased femoral
anteversion, genu valgum, lateral displacement
of tibial tubercle, or increased lateral tibial
torsion

Tubercle Sulcus Angle (Q-Angle at 90°)
PROCEDURE
• A vertical line is drawn from the center of the
patella to the center of the tibial tubercle. A
second horizontal line is drawn through the
femoral epicondyle. Normally the lines are
perpendicular
POSITIVE TEST
• Angles greater than 10° from the perpendicular
are considered abnormal. Lateral patellar
subluxation may affect the results.

Wilson Test
PROCEDURE
• The patient sits with the knee flexed over the
examining table. The knee is then actively
extended with the tibia medially rotated. At
approximately 30° of flexion (0° being straight
leg), the pain in the knee increases, and the
patient is asked to stop the flexion movement.
The patient is then asked to rotate the tibia
laterally, and the pain disappears.
POSITIVE TEST
Pain increases on the first part of the procedure
and decreases on the latter

Fairbank's Apprehension Test
PROCEDURE
quadriceps muscles relaxed and the knee flexed to
30° while the examiner carefully and slowly
pushes the patella laterally
POSITIVE TEST
• If the patient feels the patella is going to dislocate,
the patient will contract the quadriceps muscles
to bring the patella back "into line.” Patient will
also have an apprehensive look.

ILIOTIBIAL BAND FRICTION
SYNDROME

Noble Compression Test
PROCEDURE
examiner flexes the patient's knee to 90°,
accompanied by hip flexion. Pressure is then applied
to the lateral femoral epicondyle, or 1 to 2 cm (0.4 to
0.8 inch) proximal to it, with the thumb. While the
pressure is maintained the patient's knee is passively
extended
POSITIVE TEST
• At approximately 30° of flexion (0° being straight leg),
the patient complains of severe pain over the lateral
femoral condyle

Measurement of Leg Length
PROCEDURE
legs at a right angle to a line joining the two ASISs.
With a tape measure, the examiner obtains the
distance from one ASIS to the lateral or medial
malleolus on that side
POSITIVE TEST
• (+)if difference is >1.5 cm

Functional Leg Length
PROCEDURE
• The patient stands in the normal relaxed stance. The
examiner palpates the ASISs and then the (PSISs) and
notes any differences. The examiner then positions
the patient so that the patient's subtalar joints are in
neutral while bearing weight. While the patient holds
this position with the toes straight ahead and the
knee straight, the examiner repalpates the ASISs and
the PSISs. If the previously noted differences remain,
the pelvis and sacroiliac joints should be evaluated
further

POSITIVE TEST
• If the previously noted differences disappear,
the examiner should suspect a functional leg
length difference caused by hip, knee, ankle,
or foot problems-primarily, ankle or foot
problems

Special Tests - Knee

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