import { HighYieldBox, ExamCheatSheet, Tabs, Tab, ComparisonTable, VivaScenario, ContentSection, SpecialTestCard, VideoEmbed , MedicalImage} from '@/components/content' # Knee Examination The knee examination is frequently tested and must be comprehensive yet efficient. Examiners expect systematic assessment of all four ligaments, both menisci, the patellofemoral joint, and recognition of effusion. The Lachman test is considered the gold standard for ACL assessment. ## Quick Reference One-Pager ## Introduction and Setup **Start with Gait:** Observe walking for antalgic gait, thrust, locking **Patient Positioning:** - Supine for most tests - Compare with contralateral knee throughout - Sitting for patellar tracking **Exposure:** Both legs exposed from mid-thigh to ankle **Consent Script:** "I'm going to examine your knees. I'll look at both sides, feel the joints, and test the ligaments and movements. Some tests may be uncomfortable - please tell me if anything hurts." ## Look (Inspection) - **Alignment**: Varus (bow-legged), valgus (knock-kneed), recurvatum - **Muscle bulk**: Quadriceps wasting (especially VMO) - **Swelling**: Location (suprapatellar, infrapatellar) - **Scars**: Arthroscopy portals, incisions - **Posture**: Fixed flexion, hyperextension - **Effusion**: Loss of normal dimples either side of patella - **Quadriceps wasting**: Measure 15cm above patella - **Patellar position**: High (alta), low (baja), lateral tilt - **Knee position**: Fixed flexion deformity - **Skin**: Erythema, bruising, venous changes - **Patellar height**: Patella alta or baja - **Posterior sag**: PCL injury - **Flexion range**: Estimate from side - **Popliteal swelling**: Baker's cyst **Effusion Detection:** The loss of the normal concave dimples on either side of the patella is the earliest sign of effusion. More significant effusions cause suprapatellar fullness. ## Effusion Assessment **Sweep Test (Small Effusion):** 1. Sweep fluid from medial side up into suprapatellar pouch 2. Sweep down lateral side 3. Observe for fluid refilling medial side **Patellar Tap (Moderate Effusion):** 1. Squeeze suprapatellar pouch to push fluid under patella 2. Tap patella sharply downward 3. Positive: Patella taps against femur (ballotable) **Cross-Fluctuation (Large Effusion):** 1. One hand over suprapatellar pouch 2. Other hand over infrapatellar area 3. Feel fluid transmission between hands ## Feel (Palpation) **Temperature:** Use back of hand, compare sides **Bony Landmarks:** - Tibial tubercle: Prominence (Osgood-Schlatter's) - Patella: Facets, inferior pole (patella tendinopathy) - Femoral condyles: Medial and lateral - Fibular head: Lateral, LCL attachment **Joint Lines:** - **Medial joint line**: Flex knee to 90°, palpate gap between tibia and femur medially (medial meniscus) - **Lateral joint line**: Palpate laterally (lateral meniscus) **Soft Tissues:** - Patella tendon: Tenderness (tendinopathy) - Quadriceps tendon: Integrity, tenderness - Collateral ligaments: MCL, LCL - Popliteal fossa: Baker's cyst, popliteal pulse ## Move (Range of Motion) **During Movement Assess:** - Crepitus: OA, patellofemoral pathology - Catching/locking: Meniscal tear, loose body - Arc of pain: Position where pain occurs ## Special Tests ### ACL Assessment ### PCL Assessment ### Collateral Ligament Assessment ### Meniscal Assessment ### Patellofemoral Assessment ## Neurovascular Assessment **Vascular:** - Popliteal pulse (posterior, deep in fossa) - Dorsalis pedis, posterior tibial pulses - Capillary refill **Neurological:** - Common peroneal nerve at fibular neck - Sensation: Lateral leg (L5), dorsum foot (L5), sole (S1) - Motor: Foot dorsiflexion (L4,5), plantarflexion (S1,2) ## Complete the Examination **Always state to the examiner:** "To complete my examination, I would like to: - Examine the **hip** as the joint above - Examine the **ankle and foot** as the joint below - Perform **neurovascular assessment** of the lower limb - Examine the **lumbar spine** for referred pain - Obtain **X-rays** (AP standing, lateral, skyline patella)" ## Summary Presentation ## Common Conditions Table ## Video Demonstration ## Examiner Tips