What Is Knee Joint & Knee Assessment?
- Biggest joint in our body
- Hinge type of synovial joint
- Movements(Flexion, Extension, Rotation medial and lateral)
- Most weight bearing joint
- Resting position = 25 degree
- Capsular pattern : Flexion,Extension
- Close packed position : Full Extension,lateral rotation of Tibia
Knee Assessment :
Components of assessment :
- Examination of the Movement
- Special Tests
- Reflexes and cutaneous distribution
- Joint play movements
- Diagnostic imaging
Questions to be asked :
- Where did he Felt Pain ?
- How did the accident occur?
- What Is the patient able or unable to do functionally?
- Has the knee injured before?
Observation for Knee Assessment :
- Aim : Gait patterns & functional activity
- Initially Examiner should Note:
whether the patient puts weight on the affected limb or stands with only a slight amount of Weight on the affected side.
Than note :
1.Anterior view standing :
- Genu varum (bow legs) & Genu valgum (knock knees)
- Is there any swelling around the knee joint ..
Intracapsular = entire joint
Extracapsular = localized
e.g pre-patellar bursitis
2- Lateral View, Standing :
- Comparison of both sides for higher or lower patella ( patella alta or patella infera)
3- Posterior view standing :
- Look for abnormal swellings e.g Popliteal (Baker’s) Cyst.
4- Anterior and Lateral View, Sitting :
- sitting on chair or stool with knee flexed 90 degree
Knee Examination of the Movement :
Active Movements :
Passive Movements :
Functional Assessment :
Reflexes and cutaneous supply :
- Reflexes : Patellar Tendon (L3)
- Dermatomes (L3)
- Myotomes : Flexion (L5) & Extension (L3)
Special Tests :
Special Tests on knee are only performed if the examiner suspects certain pathologies & wants to do a confirming test.
Tests for swelling should always be performed.
Testing for Ligaments :
Tests for instability
- Anterior Drawer Test & Lachman Test are performed to check ACL ( Anterior Cruciate Ligament )
- Posterior Drawer Test & Sag Sign are performed to check PCL ( Posterior Cruciate Ligament )
- Varus stress test is performed to check the LCL ( Lateral Collateral Ligament )
- Valgus stress test is performed to check the MCL ( Medial Collateral ligament )
- Appley’s Test & Mucmurrey Test both can be performed for Meniscle instability
- Ober Test is performed for IT Band ( Iliotibial Band ) tightness.
Joint Play Movements for Knee Examination :
- Patient is in supine position.
- Movement on the affected side is compared with that of the normal side.
Movements are :
- Backward & Forward gliding/movement of Tibia on Femur
- Medial & Lateral translation of the Tibia on the Femur
- Medial & Lateral displacement of the Patella
- Depression of the Patella
- Anteroposterior movement of the Fibula on the Tibia.
- Supine lying & knee slightly flexed
- Meniscal cysts = 45 degree
- Joint line = 90 degree
Anterior Palpation with knee extened :
- Patella,Patellar Tendon,Quadriceps Muscles,Medial Collateral Ligament,Pes Anserinus(apponeurosis of tendons of gracilis,semi-tendinosus & Sartorius),TFL & IT band.
With knee flexed :
- Adductor muscles,meniscal cyst,TFJ line at 90 degree,tibial plateau ,femoral condyles.
With foot resting on the normal Leg :
- Lateral collateral ligament
Posterior Palpation with knee slightly flexed :
- Posterior, Posterolateral & Posteromedial aspects of knee
- Hamstring Muscles
- Gastrocnemius muscles
Plain Film Radiography
- For Knee evaluation
Anteroposterior and lateral views are most commonly obtained.
- Other diagnostic imaging tools are
Computed tomography (CT SCAN) &
MRI (Magnetic Rasonance Imaging)
Xeroradiography may be used to delineate the edge of bone.
A good Physiotherapist should Know The Knee Anatomy & Assessment.