Knee Joint Assessment By : Fahad Iftikhar DPT

What Is Knee? 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 joint Tibio-Femoral joint

Assessment : Components of assessment : History Observation Examination of the Movement Special Tests Reflexes and cutaneous distribution Joint play movements Palpation Diagnostic imaging

History : Questions to be asked : Q#1: How did the accident occur? Has the knee injured before? Q#3: What Is the patient able or unable to do functionally?

History Q#4: Is there any clicking or was there any PoP when the injury occured? POP = Anterior cruciate ligament tear or osteochondreal fracture. Q#5: Is there any pain? what is its intensity & what type is it?

Observation : 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 : 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

Observation 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

Observation Patella Baja(Infera) - Normal - Patella alta

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.

Special Tests : Testing for Ligaments : Tests for instability One-plane Medial (Hughston’s valgus stress Test) One-plane Lateral (Hughston’s varus stress Test) One-plane Anterior (Lachman Test) (Drawer Test) One-plane Posterior (Drawer Test) There are also various tests for Anteromedial,anterolateral & anteroposterior Rotary instability.

Joint Play Movements : 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.

Palpation : 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 Test Leg : Lateral collateral ligament

Posterior Palpation with knee slightly flexed : Posterior, Posterolateral & Posteromedial aspects of knee Hamstring Muscles Gastrocnemius muscles

Diagnostic Imaging 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 : Xeroradiography may be used to delineate the edge of bone.