The examination of the knee is a key musculoskeletal examination to master. It is commonly tested in OSCE exams and more importantly, if you end up working in general practice or in the emergency department, chances are you will need to be able to distinguish between a simple strain and damage to key ligaments. In this section we will cover how to assess the knee joint using a systematic approach.
“Hi, my name is Han Solo and I am a 4th year medical student”
Check patient details
“I have been asked to examine your knee today. This involves having a look, a feel and asking you to do a few exercises.”
Gain verbal consent
“Would this be ok with you?”
General end of bed inspection
Knee inspection anterior and posterior (standing)
Ask the patient to lie on the bed and further inspect the knees
NB - Remember to talk through what you are doing, both for the sake of the patient (bit awks to just stare at people’s body parts for extended periods of time) and the examiner.
“I am just going to be checking your knee to make sure it has a nice normal alignment, and also ensuring there are no swellings or skin changes.”
Start with the patient lying down in the bed with the knees exposed
NB - Ask the patient before starting if they have any pain in their knee. When feeling the patient’s knee ask them to let you know if there is any pain when you palpate.
Check for effusion
Knee joint palpation
NB - Most clinicians will start with the good knee first. Both building trust with the patient and also giving you an idea what the good side feels like.
Assess active movement
Assess passive movement
“ Now I will be doing the same movements, but I just need you to relax and let me take the full weight of your leg.”
“Relax and can you make your leg go nice and floppy?”
Look for evidence of hyperextension
Anterior draw test (Anterior cruciate ligament) and Posterior draw test (Posterior cruciate ligament)
NB - Significant movement forward indicates ACL laxity or damage and likewise significant backward movement indicates PCL laxity or damage.
Medial and lateral collateral ligament
NB - Remember you are testing the ligament opposite to the pressure area. For example, if you are applying pressure to the medial aspect of the knee and notice excessive movement then it likely indicates lateral collateral damage.
“That’s the end of the exam. Thank you for your time. Would you like any help getting dressed?”
State other exams for completion
“To complete the examination I would examine the ankle and the hip joints as well as conducting a full lower limb neurological assessment.”
State what investigations you would perform