Dr. Ebraheim's animated educational video describes the history and examination of painful and injured knee.
A history of dashboard injury or fall onto a plantarflexed foot will cause a posterior cruciate ligament PCL injury.
PCL injury is examined by performing the posterior drawer test. The posterior drawer test will be done in 70-90 flexion. Watch for the sag. The amount of translation in relationship to the femur is observed. In general if the knee is bent or the foot is plantar flexed, this can give you a PCL injury. However, if the knee is extended, in valgus or there is a hyperextension injury, this can give you an ACL injury.
A noncontact pivoting injury with large swelling of the knee after hearing a “Pop” is usually an anterior cruciate ligament injury ACL. The middle genicular artery will be injured and there will usually be hemorrhaging inside the knee joint. The Lachman’s test is used to diagnose injury of the ACL.
Lachman’s test
•Bend the knee to about 20-30 degrees of flexion.
•The tibia is reduced and when you pull it forward, the instability can be seen.
•At this point the tibia is subluxed forward.
Pivot shift test
•The pivot shift test is also done for ACL tears.
•It is used more for chronic ACL tears.
•The pivot shift test is different from the Lachman’s test.
•When the knee is straight, the lateral tibial plateau will be subluxed in extension.
•In 20-30 of flexion, it will be reduced in flexion by the iliotibial band.
Patellar fracture
•If the patient has a history of a fall onto a dorsiflexed foot, the patient may have a patellar fracture. The patella can fracture due to a direct impact injury or indirect due to eccentric contraction.
Meniscal injury
•Occurs due to a twisting injury. There will be some swelling and pain that is worse with twisting or squatting motions. The patient may complain of locking of the knee.
•Examination will show joint line tenderness which is specific of a meniscal injury.
•The McMurray’s test is used to diagnose the presence of meniscal tear.
McMurray’s test
•A painful click may be obtained as the knee is brought from flexion to extension in either internal or external rotation.
•There will be a “click” or “pop” with valgus plus external rotation with injury to the medial meniscus.
•A “click” or “pop” sensation will be felt during internal rotation and extension of the knee with injury to the lateral meniscus.
Pain in the knee around the patella with climbing stairs or during sitting may be a sign of a patella problem.
The lateral patellar apprehension test is performed to check the knee for symptoms of dislocating or subluxing patella.
Lateral patellar apprehension test
•With the finger placed on the patella medially, try to push the patella laterally.
•If this causes pain and apprehension, then the test is considered positive.
Isolated injuries of the posterolateral corner are rare and often cause instability and varus thrust. By performing the dial test, you can detect if there is an isolated or combined injury of the posterolateral corner of the knee.
Dial test
•In isolated posterolateral corner injury, the dial test will be positive at 30 of flexion.
•The test is better when done in the prone position and always compare the two sides together.
•Flexion at the 90 angle will test the posterior cruciate ligament (PCL) for injury.
•More than 10 of external rotation asymmetry at 30 and at 90 is consistent with posterolateral corner and PCL injury.
Medial collateral ligament tear (MCL)
•Pain on the inside of the knee with “ a popping” sound after a blow to the outside of the knee, this is probably a sign of medial collateral ligament (MCL) injury.
•The typical mechanism of injury of the MCL is due to a valgus and external rotation force.
•Proximal tear of the MCL usually heals well, and this is the most common location of the tear.
•Examine the MCL with the valgus stress test (30 of flexion).
•The valgus stress test at 30 of flexion tests the superficial part of the medial collateral ligament (MCL).
•If the MCL appears to be lax in 0 of extension, then this will signal a combined injury (MCL plus other ligaments and possibly posterior capsule injury).
Lateral collateral ligament tear (LCL)
•Lateral collateral ligament (LCL) injuries result from a varus force across the knee. Contact injury, such as a direct blow to the medial side of the knee, or a non-contact injury, such as hyperextension stress, which may result in a varus force across the knee injuring the LCL.

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