1. Knee Joint
Assessment
By : Fahad Iftikhar
DPT

2. 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

3. Knee joint
Tibio-Femoral joint

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

6. 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?

7. 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?

8. 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

9. 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

10. Observation
Patella Baja(Infera) Normal Patella alta

11. 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)

12. 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.

13. 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.

14. 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.

15. 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

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

17. 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)

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