KNEE EXAMINATION STRESS TESTS

TESTS	POSITION OF THE KNEE	STRUCTURES INVOLVED	DESCRIPTION OF TEST BEING PERFORMED	*MOUSE OVER* PICTURE TO VIEW MOVIE
Gravity Sign/Gravity Test	Knees and hips flexed 90 degrees. Held by examiner.	Posterior Cruciate and/or Posterior Oblique Ligament and/or Fibular Collateral Ligament, Popliteus Tendon, Arcuate Ligament.	Patient lies supine with hip flexed to 45 degrees and the knee to 90 degrees. The tibia will "drop back" or sag back on the femur if the posterior cruciate is torn. Must observe both knees, because if the sag isn’t noticed, it could give you a false positive anterior drawer.
Posterolateral Drawer Test	Knee flexed 90 degrees. Lower leg in neutral rotation.	Popliteus Tendon, Fibula Collateral Ligament, Arcuate Ligament	Patient lies supine with knee flexed 80-90 degrees, and hip to 45 degrees. Examiner medially rotates the patients foot slightly and sits on the foot to stabilize it. Examiner pushes tibia posteriorly. If tibia moves or rotates posteriorly on the medial aspect an excessive amount compared to the normal knee, the test is positive.
Figure 4 Palpation	Leg flexed and crossed over the opposite knee	Fibula Collateral Ligament	Patient is supine with affected leg flexed and crossed with affected foot across other knee. Observe area around the medial joint line for any indentions that would reflect ligament damage.
Lateral Compression	From flexion to extension	Lateral meniscus and/or Lateral Joint internal derangement such as osteochondritis dessicans or osteochondral fractures.	Flexing and extending the knee while apply valgus stress. Repeat with lower leg held in internal rotation and then external rotation.
Medial Compression	From flexion to extension	Medial meniscus and/or Medial joint internal derangement, such as osteochrondritis dessicans or osteochondral fracture.	Flexing and extending the knee while applying various stress. Repeat with the lower leg held in internal rotation and then external rotation.
Jerk Test of Hughston	Hip flexed 30-35 degrees, knee flexed about 80 degrees. Knee goes from flexion to full extension.	Anterior Cruciate and/or Lateral Capsular ligaments.	Knee is flexed to 80 degrees and the foot is internally rotated. Apply a valgus force while attempting to rotate the fibula medially as the knee is being straightened. The jerk test takes place at approximately 20 degrees of flexion.
Hyperextension External Rotation recurvatum	Legs are fully extended and are held up from the toes by the examiner.	Anterior Cruciate ligament. It may or may not involve the posterior cruciate ligament. Rotary instability may be present. Fibula Collateral Arcuate Ligament.	The foot is raised to allow the knee to drop back into hyperextension; this is compared with the opposite side.
McMurray’s	Fully flexed	Lateral Meniscus, Medial Meniscus	The foot is held in one hand while the other hand palpates the joint line on both sides of the knee. A click or grinding may indicate a tear of the posterior segment of the meniscus while flexing and extending the knee.
Apley’s Grind Test	Flexed to 90 degrees	Medial or lateral menisci and/or other internal derangement, such as osteochondritis dessicans or osteochondral fractures.	Athlete is prone with knee flexed to 90 degrees. Pressure is then applied to the heel while the foot is rotated. This suggests a posterior horn injury.