Examination of the knee joint

The knee joint is a joint of the lower limb, which consists of three joints: the femoropatellar (connection between the femur and patella ), the Tibiofemoralgelenk (connection between the shin and thigh bone) and the tibiofibular joint (joint between tibia and fibula ). Due to the anatomical conditions, different types of malformations, injuries or diseases of this joint can result, the examination of the knee joint should therefore provide an overview of the possible differential diagnoses.

In addition to the anamnesis , the inspection and physical examination are an important part of confirming the diagnosis, and imaging or invasive procedures are added later. The side comparison is of great importance in the orthopedic examination, each of these examinations is therefore carried out on both legs and documented separately in order to perceive conspicuous side differences.

Clinical investigation methods

Examination in the supine position

• Zohlen sign : The examiner fixes and distalizes the patella with the leg extended and then asks the patient to slowly tense the quadriceps femoris muscle .
• Böhler's sign : With the knee joint extended, the examiner adducts and abducts the lower leg against the thigh.
• Drawer test : With the knee joint bent at 90 °, the examiner pulls or pushes the lower leg to move it against the thigh.
• Lachmann's sign : Like the drawer test, but with the knee joint slightly angled, i.e. 25–30 °
• Steinmann's sign I: With the knee joint flexed 90 °, the examiner turns and compresses the lower leg inwards or outwards.
• Steinmann's sign II: An initially ventral pain in the knee joint moves dorsally with increasing flexion.
• Signs of the dancing patella : With the knee extended, the examiner pushes the potential joint effusion from above the knee towards the joint, fixes this position and then presses the kneecap with the other hand.
• McMurry test : With the knee and hip joint flexed by 90 °, the examiner performs maximum internal and external rotation of the foot and lower leg.
• Pivot-shift test : With the knee joint extended, the knee joint is flexed under valgus stress and internal rotation.

Examination in the prone position

• Apley Grinding Test : With the knee bent at 90 °, the examiner rotates the lower leg inwards and outwards, once under pressure and once under tension.

Examination sitting cross-legged

• Payr sign : the patient sits cross-legged and the examiner pushes the knee down.

Clinical examination according to the location of the injury

Injury to the cruciate ligament

• Drawer test
• Laughman sign
• Pivot Shift Test

Injury to the meniscus

• Steinmann I sign
• Steinmann II sign
• Böhler sign
• Payr sign
• Apley grinding test

Injury to the cartilage

• Zohlen sign

Imaging procedures

When imaging methods are x-ray , sonography , arthrography (hardly applied more), magnetic resonance imaging (MRI) and computed tomography (CT) is used. An arthroscopy can be used to view internal structures.