Dr. Ebraheim’s educational animated video describes test for evaluation of knee injuries and all the maneuvers you need to know to preform an excellent knee examination.
McMurray’s test is a knee examination test that shows pain or a painful click as the knee is brought from flexion to extension with either internal or external rotation. The McMurray’s test uses the tibia to trap the meniscus between the femoral condyles of the femur and he tibia.
Lachman’s test is the most sensitive examination test for ACL injury. The anterior cruciate ligament is located in the front of the knee. The ACL keep keeps the tibia from sliding out in front of the femur and provides rotational stability to the knee.
The Pivot shift test is a specific test for ACL deficient knee (ACL injury). Pivot shift is pathognomonic for an ACL tear and is best demonstrated in a chronic setting. Lachman’s test is the most sensitive test for CL injury. The ACL keeps the tibia from sliding pout in front of the femur and provides rotational stability to the knee. Rupture of the ACL causes anterolateral rotatory instability. The Pivot shift test goes from extension (tibia subluxed) to flexion, with the tibia reduced by the iliotibial band.
The reverse Pivot shift test helps to diagnose acute or chronic posterolateral instability of the knee. A significantly positive reverse Pivot shift test suggests that the PCL, the LCL, the arcuate complex and the popliteal fibular ligament are all torn.
The reverse Pivot shift test begins with patient supine with the knee in 90 degrees of flexion. Valgus stress is then applied to the knee with an external rotation force. Bring the knee from 90 degree of flexion to full extension. The tibia reduces from a posterior subluxed position at about 20 degrees of flexion. A shift and reduction of the lateral tibial plateau can be felt as it moves anteriorly from a posteriorly subluxed position. A clunk occurs as the knee is extended. This is called the reverse Pivot shift test because shift of the lateral tibial plateau occurs in the opposite direction of the true pivot shift (seen in ACL tears). If the tibia is posterolaterally subluxed, the iliotibial band will reduce the knee as the IT band transitions from a flexor to extensor of the knee. It is very important to compare this test to the contralateral knee.
The Posterior drawer test is the most accurate test for PCL injury. The posterior cruciate ligament is located in the back of the knee. The PCL is the primary restraint to the posterior tibial translation. Injuries to the PCL are not as common as other ACL injuries.
The Dial test is performed to diagnose posterolateral instability due to posterolateral corner injury with or without PCL injury. Isolated injuries of the posterolateral corner are rare and often cause instability and varus thrust. By performing the Dial test you can detect whether there’s an isolated or combined Injury of the posterolateral corner of the knee.
The varus stress test checks for joint laxity on the outside of the knee, which usually represents an injury to the lateral collateral ligament. Palpate around the knee in order to check for injury to the LCL. Apply a varus force to the knee. The LCL needs to be checked for an end point. Isolated tear of the LCL is tested at 30 degrees of flexion. With the MCL isolated and the knee flexed to 30 degrees, move the knee from side to side to access for stability of the knee. Next place the knee back into 0 degrees of full extension and test the stability of the LCL in the same way. A positive test demonstrates increased lateral joint laxity compared to the unaffected side. Varus instability at 0 degrees and 30 degrees of flexion indicated a combined injury of the LCL and the cruciate ligaments.
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