Look
Stigmata Generalised disease
- Marfan's
Ligamentous laxity Wynne Davies
- positive if 3/5 pairs
- thumb touches volar forearm
- fingers parallel to forearm dorsally
- elbow hyperextends past 0o
- knee hyperextends past 0o
- ankle dorsiflexes > 45o
Front
VMO bulk
Swelling
Scars of previous surgery i.e. TTT
Planovalgus Feet / Hyperpronation
Genu Valgum
Squinting patella
- Proximal Femoral Anteversion (PFA)
- patellae point inwards when standing
Grasshopper eyes
- patellas sit high & lateral
- due to patella alta
- patella subluxed laterally
Side
Flexed attitude Knee
Scars
Back
Level Popliteal creases
Valgus Heels
Gait
Foot Progression Angle
- Normal 10° (0-30°)
- any in-toeing
- indicative of PFA
Sit on ege of Bed
Patella Tracking
- J sign
- lateral subluxation in terminal extension
Crepitus
Supine
Effusion
3 signs in Extension
1. Tenderness
- tibial tuberosity
- lateral patella retinaculum
- patella
- Bassett's sign (MPFL on med epicondyle)
- pain with patella grind (compression)
2. Clark's test
- gentle pressure on superior pole
- patient asked to contract quadriceps
- compare with other side
3. Patellar Tilt Test
- Patient supine and relaxed with knees extended
- Trans- epicondylar axis placed parallel to table
- Lateral edge of patella elevated & medial edge depressed
- normal is lateral tilt 0-20°
- Abnormal if unable to tilt to horizontal
- indicated lateral retinaculum tightness
3 Signs in 30o Flexion
1. Q angle
- Knee at 30° flexion so patella engages femoral sulcus
- ASIS to centre of patella to tibial tuberosity
- abnormal > 15° in males
- abnormal > 20° in female
2. Patellar glide test (Sage Mobility)
- Graded by number of 1/4 widths that patella displaces
- > 3 insufficient medial restraints
- < 1 tight lateral retinaculum
- > 3 insufficient lateral restraints
3. Apprehension test
- patient supine and relaxed
- patella pushed laterally while knee flexed 30o
- positive if patient uncomfortable (pain or apprehension)
Prone / Rotational profile
Best is all assessed prone
1. Lateral border of foot
- metatarsus adductus
2. Tibial Torsion
- thigh foot angle > 15o
- trans-malleolar axis > 30o
3. Femoral anteversion
- excessive IR
- increased Gage's trochanteric angle