• Gait:
    • Heel strike, stance, toe off, swing phases
    • Observe for smooth, rhythmic motion, with knee extended only at heel strike of gait cycle
  • Posture in standing:
    • General knee contours
    • Anterior and posterior
      • Genu varum (bowleggedness), genu valgum (knock knees), hyperextension, or flexion contracture
      • Patellar position: patella baja (low rising)/alta (high rising), tilting, rotation, lateral patellar tracking
      • Muscle contour (eg. Quadriceps atrophy)
      • Osgood-Schlatter: a benign yet sometimes painful knee disease in active teenagers. Manifests as a raised and often tender bump inferior to the patient's affected knee(s)
    • Lateral view
      • Observe for hyperextension or flexion contracture
    • Measure leg length with true leg length test
      • Patient supine, measure from ASIS to medial malleolus of ipsilateral leg


  • Note areas of pain, swelling, spasm, muscular atrophy, ligamentous laxity, deformity, bogginess or crepitus in the following structures
  • Patient sitting with calfs dangling and knees relaxed

Medial compartment

  • Medial meniscus
  • Medial femoral condyle
  • Adductor tubercle
  • Medial tibial plateau
  • Medial collateral ligament
  • Tibiofemoral joint

Lateral compartment

  • Lateral meniscus
  • Lateral femoral condyle
  • Lateral tibial plateau
  • Head of fibula
  • Lateral collateral ligament
  • Tibiofemoral joint

Patellofemoral compartment

  • Patella
  • Patellar tendon
  • Tibial tuberosity
  • Pre-patellar bursa

Bursae (assess for pain, heat and bogginess/swelling)

  • Suprapatellar bursa (above superior border of patella)
  • Pre-patella bursa (overlying patella)
  • Anserine bursa (posteromedial knee, inserts on medial tibial plateau)
  • Semimembranosus bursa (medial popliteal fossa)


  • Popliteal fossa (Baker's cyst) Note: Usually a benign finding
  • Gastrocnemius and soleus muscle

Special Palpation Tests

  • Patellofemoral grind test
  • Suprapatellar pouch (start 10 cm above superior border of patella)
  • Minor Effusions bulge sign
  • Major Effusions ballottement sign and balloon sign
  • Range of Motion

    • Flexion (normal = 135°) “Bend knee”
    • Extension (normal = 10°) “Straighten knee”
    • Internal rotation (normal = 10°) "Swing lower leg toward midline"
    • External rotation (normal = 10°) "Swing lower leg away from midline"

    Special Tests

    Ligamental integrity



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