ROM MMT

Knee flexion Knee Flexion (all hamstring mm)

Px supine with knee in extension (place a towel sa ankle)
Normal values: 130 to 140 degrees
End feel: Soft due to contact between muscle bulk
Fulcrum - lateral femoral epicondyle
Proximal - greater trochanter of femur
Distal - lateral malleolus of the fibula
Stabilization: femur to prev hip rot. Abd., and add
PT: Hold the ankle in one hand and the anterior thigh with the
other hand. Move the individual’s thigh to approximately 90 Patient: Prone with legs straight and toes hanging over the
degrees of hip flexion and move the knee into flexion. Stabilize edge of the table. (Gr3-5)
the thigh to prevent further hip motion and guide the lower leg PT: Stand next to limb to be tested. Ask the patient to flex the
into knee flexion. knee as far as possible (Gr3). Observe possible tightness in the
rectus femoris that may be indicated by limited knee flexion or
the hip flexing. During 45 degrees of flexion, Hand provides
resistance on posterior surface of the leg just above the ankle.
The other hand provides stabilization over the hamstring
tendons on the posterior thigh (optional) “Hold it! Don't let
me straighten it.” (Gr4-5)
Medial Hamstring Test (Semitendinosus and
Semimembranosus)
Knee Extension
Px supine with knee in flexion (place a towel sa ankle)
Normal values: 0 to 135 degrees
End feel: Firm due to tension in capsule
Fulcrum - lateral femoral epicondyle
Proximal - greater trochanter of femur
Distal - lateral malleolus of the fibula
Stabilization: femur to keep hip in neutral abd, add, and rot
PT: The examiner should place one hand on top of the lower
thigh and exert a slight downward pressure

Patient: Prone with knee flexed to 45°. Leg in internal rotation

(toes pointing toward midline).
Maneuver : Patient flexes knee, maintaining the leg in internal
rotation (heel toward therapist, toes pointing toward midline).
Therapist resists knee flexion at the ankle using a downward
and outward force

Lateral Hamstring Test (Biceps Femoris)

Patient: Prone with knee flexed to 45°. Leg is in external

rotation (toes pointing laterally).
Maneuver: Patient flexes knee, maintaining leg in external
rotation (heel away from therapist, toes pointing toward
therapist) Therapist resists knee flexion at the ankle using a
downward and inward force.
 Knee Extension (Quadriceps Femoris)

Patient: Side-lying with test limb (uppermost limb) supported

by therapist or resting on suitable height stool. Lower limb Patient: Short sitting. Place a towel roll under the patient's
flexed for stability. .(Grade2) distal thigh for comfort. (Gr 3-5)
PT: Stand behind patient at knee level. One arm is used to PT: Stand at side of limb to be tested. Ask the patient to
cradle thigh, providing hand support at medial side of knee. straighten the knee. (Gr3). Position the knee in approximately
Other hand supports the leg at the ankle just above the 15 deg of knee flexion. Place the palm of the hand providing
malleolus . “Bend your knee.”(Grade2) resistance over the anterior surface of the distal leg just above
the ankle, using a straight arm technique because of the
potential strength of these muscles. “Hold it! Don't let me bend
it.”(Gr 4-5)

Patient: Side-lying with test limb uppermost. Lowermost limb

may be flexed for stability. Limb to be tested is held in about
90° of knee flexion. The hip should be in full
extension .(Grade2)
PT: Stand behind patient at knee level. One arm cradles the test
limb around the thigh with the hand supporting the underside
of the knee “Straighten your knee.”.(Grade2)

Patient: Prone. Limbs are straight with toes extending over end
of table. Knee is partially flexed and supported at ankle by
therapist. gr1-0)
PT: Stand next to test limb at knee level. (Therapist shown on
opposite side to avoid obscuring test position.) One hand
supports the flexed limb at the ankle. The opposite hand Patient: Supine.gr1-0)
palpates both the medial and the lateral hamstring tendons just PT: Stand next to limb to be tested at knee level. Hand used for
above the posterior knee. “Try to bend your knee.” (gr1-0) palpation should be on the quadriceps tendon just above the
Grade 5 for All Three Tests: Patient holds test position against knee with the tendon “held” gently between the thumb and
maximal resistance. fingers. The therapist also may want to palpate the patellar
Grade 4 for All Three Tests: Holds test position against strong tendon just below the knee “Push the back of your knee down
to moderate resistance. into the table.” OR “Tighten your kneecap” (gr1-0)
Grade 3 for All Three Tests: Patient completes full range of
motion without external resistance
Grade 2: Completes available range of motion in side-lying
position, with gravity minimized.
Grade 1: Tendons become prominent, but no visible movement
occurs.
Grade 0: No discernable contraction of the muscles; tendons
do not stand out.
O’Donoghue’s Test Childress Sign
Patient: Prone Patient: standing or full squat
PT: Passively flex the knee to 90 deg and ROTATE TIBIA PT: Instruct patient to go in a full squat position and do the
INTERNALLY and EXTERNALLY twice. Then, fully extends the “duck waddle” back and forth, and side to side.
knee and repeats rotations. (+) Posterior horn lesion of meniscus = pain, clicking, snapping
(+) meniscal tear or joint capsule irritation = increased pain
during rotation in either or both knee positions

Modified Helfet Test - to assess screw home mech of

tibiofemoral jt.
Patient: seated with legs hanging
Payr’s Test PT: Locate center of patella and center of tibial tuberosity and
Patient: supine with legs in figure four position mark them. Ask patient to extend knee and observe the
PT: Passively push the px knee downward marked points at full extension.
(+) meniscus lesion = pain in medial joint line (+) ligamentous instability, meniscal damage, muscular
imbalance = tibial tuberosity fails to move laterally and will not
be able to demonstrate external rotation of tibia

Bohler’s Sign
Steinman Test
Patient: supine
Patient: supine
PT: Apply varus and valgus stress to the knee.
PT: Passively bring the patient’s knee to full flexion, then back
(+) meniscus pathology = pain in opposite joint line
to extension.
(+) Posterior horn lesion of meniscus = point tenderness and
pain on jt. Line that appears to move anteriorly when the knee
is extended and moves posteriorly when the knee is flexed.

Bragard’s Sign
Patient: supine
PT: Passively flex the patient’s knee, laterally rotate the tibia,
then extend the knee.
(+) medial meniscus pathology = pain and tenderness
Slocum Test
Patient: supine , hip flexed to 90, knee to 45, 15 lateral
rotation on foot, tibia to 30 deg medial rotation of tibia
PT: Sitting on patient’s foot with fingers placed behind the
tibia, and thumbs in anterior joint line to palpate tibial
PT: Passively medially rotate the tibia, then flex the patient’s translation. Then, draw the tibia forward.
knee. (+) Anterior cruciate ligament and/or lateral collateral ligament
(+) medial meniscus pathology = decreased pain and tear or laxity = movement primarily occurs on the lateral side of
tenderness the knee
 ensure that hamstrings are relaxed. Other hand on the patella
Lateral Pivot Shift Test with the thumb hooked behind fibular head. Apply valgus
Patient: supine, hip flexed to 45 with 35 degrees abd, relaxed force on knee, this will compress structures in lateral
in 20 medial rot compartment and make anterior subluxation (if present) more
PT: Grasp the calcaneus and apply tibial internal rotation to noticeable. PT can use their abdomen as a fulcrum while
provoke subluxation. To induce tibial internal rotation, apply extending the patient’s knee and applying forward pressure
axial compression directed cranially. With other hand, provide behind the fibular head. The foot and ankle are allowed to drift
slight valgus force on the lateral knee joint. While maintaining into medial rotation so if the foot and ankle are not allowed to
IR, move the patient’s knee from extension to 30 degrees do so. The anterior subluxation of the lateral tibial plateau may
flexion. be prevented.
Note: protective muscle contraction or guarding may lead to a (+) Posterior horn lesion of meniscus = clunk forward just
false negative test, make sure that the extremity of the patient before the full extension of the knee. This presents that the
is relaxed. tibia has subluxated anteriorly and indicates injury to the same
(+) possible structures injured: ACL, posterolateral capsule, structures as those indicated by pivot shift test.
arcuate-popliteus complex, lateral collateral ligament,
iliotibial band = clunk sound, giving way feeling from px, or if
the tibia subluxes forward as the knee extends and followed by
a reduction or when the tibia jogs/pulled backward at 30-40
degrees of knee flexion due to the tightened ITB (flexor).

Losee Test
Patient: supine
PT: Hip flexed to 45 and knee flexed to 90. One hand on
fibular head to produce medial rotation of tibia and valgus
force. Extend the leg.
Crossover Test of Arnold (+) possible structures injured: ACL, posterolateral capsule,
Patient: cross the uninvolved leg in front of involved leg arcuate-popliteus complex, lateral collateral ligament,
PT: The examiner then carefully steps on the patient’s involved iliotibial band = sudden jerk during the movement at approx.
foot to stabilize it and instructs the patient to rotate the upper 20 to 30 deg of flexion
torso away from the injured leg approximately 90° from the
fixed foot. When this position is achieved, the patient contracts
the quadriceps muscles, producing the same symptoms and
testing the same structures as in the lateral pivot shift test.
(+) possible structures injured: ACL, posterolateral capsule,
arcuate-popliteus complex, lateral collateral ligament,
iliotibial band = clunk sound, giving way feeling from px, or if
the tibia subluxes forward as the knee extends and followed by Plica Stutter Test
a reduction or when the tibia jogs/pulled backward at 30-40 Patient: seated
degrees of knee flexion due to the tightened ITB (flexor). PT: Place finger over the patella to palpate while client slowly
extends the knee.
(+) plica lesions = patella stutters or jumps somewhere
between 60 and 45 during an otherwise smooth movement.
Note: can only do this if no joint swelling is present

Losee Test
Patient: supine
PT: Hold patient’s ankle and foot to laterally rotate the leg to
reduce subluxation. Passively flex knees to 30 degrees and
Hughston’s Plica Test Sweep Test
Patient: supine Patient: supine
PT: Passively flex the knee and medially rotate tibia. Other PT: Swipe the hands upward from the patella to the thigh,
hand press on patella medially with the heel of other hand three sweeps and two to three from the lateral side. PT should
palpating medial femoral condyle with fingers of same hand. observe for any fluid moving inside of knee.
Patient’s knee is passively flexed and extended while PT feels (+) minimal effusion or swelling of knee jt. = fluid moving on
for popping of plica under fingers. medial part of knee
(+) plica lesions = popping under PT’s fingers upon palpation
Clarke’s Sign
Patient: supine
PT: Press down slightly proximal to the upper pole or base of
patella. Ask patient to contract the quadriceps muscle while
pressing down
(+) Patellofemoral dysfunction/chondromalacia patellae =
retropatellar pain or cannot hold contraction
Brush, Stroke, or Bulge Test (wipe test)
Normal: 1 to 7 ml of synovial fluid
Patient: supine
PT: Stroke the medial side of the knee 2 to 3 times with the
palm and finger proximally. Then, stroke down the lateral side
of knee.
Waldron’s Test
(+) minimal effusion or swelling of knee jt. = wave of fluids
Patient: standing
flowing down the medial side of knee
PT: Palpate the patella and instruct the patient to perform
slow deep knee bends or squats
(+) Patellofemoral dysfunction= crepitus with pain

Patellar Tap Test - can detect a large amount of swelling in the

knee.
Patient: supine
PT: One hand strokes up towards the apex of patella while
applying force. Other hand strokes down towards suprapatellar
pouch while applying force. Take index finger and press onto Wilson’s Test
patella and see it it is floating. Patient: sitting, with knee flexed over table
(+) minimal effusion or swelling of knee jt. = patella is floating PT: Instruct patient to extend the knee with tibia medially
while tapping onto it which means fluid has accumulated under rotated. At approximately 30° of flexion, the pain in the knee
it. increases, and the patient is asked to stop the flexion
movement. The patient is then asked to rotate the tibia
laterally, and the pain disappears.
(+) Osteochondritis dissecans= pain disappears in external
rotation of tibia
Fluctuation Test
Patient: supine
PT: One hand on the suuprapatellar pouch and other hand on
anterior to the joint with thumb and index finger just beyond
margins of patella. Press down with one hand and then the
other, the examiner may feel the synovial fluid fluctuate
under the hands and move from one hand to the other.
(+) minimal effusion or swelling of knee jt. = shows sign of
fluctuation
Fairbank’s Apprehension Test press on medial side of patella. Tis exerts laterally directed
Patient: supine, with quads relaxed and knee flexed to 30 pressure on patella.
PT:Slowly push the patella laterally (carefully). patella should (+) Subluxed or Dislocated Patella = patient is surprised by
be pushed laterally and distally to make the test more lateral displacement of patella, may feel uncomfortable or
sensitive. apprehensive as paella reaches maximal lateral displacement,
(+) Dislocation of patella= the patient feels the patella is going or reach for your hand or attempt o extend knee to pull patella
to dislocate, the patient contracts the quadriceps muscles to back to resting position.
bring the patella back “into line.”or patient with apprehensive
look.

Renne Test
Patient: standing near a wall
PT: wall and PT’s shoulder are used for patient’s balance. Ask
Moving Patellar Apprehension Test
patient to lift the leg of unaffected side. Then, patient is asked
Patient: supine
to “squat down” on the WB leg. Palpate for the lateral femoral
PT:Hold the leg in full extension off the table. PT translates
condyle. Ask patient to slowly flex the knee up until 60 to 90
patella laterally using the examiner’s thumb, and the patella is
deg flexion and rise back up. Perform again.
held laterally while passively flex the knee to 90 and return leg
(+) ITB syndrome = pain, crepitus or snapping in lateral
to full ext (step 1). the patella is then translated medially and
epicondyle of femur
the knee flexed, there will be no apprehension or protective
quadriceps contraction (part 2)
(+) Patellar Instability = patient apprehension or contraction of
the quadriceps. For the test to be positive, both step 1
(apprehension) and step 2 (no apprehension) must occur.

Passive Knee Extension Test

Patient: supine, hip flexed to 90
PT: extends the knee until reaching the maximal tolerable
stretch of the hamstring muscle as indicated by the patient
with the ipsilateral hip remaining in 90 of flexion. The knee
angle is then measured with a goniometer.
Normal test values: 180 degrees
Fulcrum: lateral epicondyle of the femur
Moving arm: lateral malleolus
Stationary arm: greater trochanter
(+) Tightness of Hamstring = onset of pain or discomfort

Patellar Apprehension Test

Patient: long sitting or supine with knee flexed to 30 deg
PT: place pillow underneath patient’s knee for comfort. Ask
patient they want to be draped. Quads should be relaxed which
will allow movement of patella. With thumb of both hands,
Pivot shift test stable Lachman test (modification 2)

Patient: lies supine with the knee resting on the examiner’s

knee
PT: One of the examiner’s hands stabilizes the femur against
Patient: sits with the foot on the floor in neutral rotation and the examiner’s thigh, and the other hand applies an anterior
the knee flexed 80° to 90°. stress.
PT: ask the px to isometrically contract the quadriceps while (+)ACL injury = Abnormal forward motion of tibia
the examiner stabilizes the foot to avoid knee motions drop leg Lachman test (modification 3)
(+) anterolateral instability = anterolateral subluxation of the
lateral tibial plateau
Lever sign or Lelli’s test

Patient: lies supine, and the leg to be examined is abducted off

the side of the examining table and the knee is flexed to 25°.
PT: examiner’s hands stabilize the femur against the table while
Patient: supine, legs fully extended the patient’s foot is held between the examiner’s knees. The
PT: place fist over the proximal calf (posterior), apply moderate examiner’s other hand is then free to apply the anterior
downward foce over the distal 1/3 of the quads translation force
(+)ACL injury = anterior translation of the tibia (+)ACL injury = Abnormal forward motion of tibia
Lachman test (Ritchie, Trillat, or Lachman-Trillat test,) Modification 4

Patient: supine with the involved leg beside the examiner.

Patient: patient lying supine while the examiner stabilizes the
PT: examiner holds the patient’s knee between full extension
foot between the examiner’s thorax and arm.
and 30° of flexion. femur is stabilized with one of the
PT: Hands are placed around the tibia, the knee is flexed 20° to
examiner’s hands (the “outside” hand) while the proximal
30°, and an anterior drawer movement is performed
aspect of the tibia is moved forward with the other (“inside”)
(+)ACL injury = Abnormal forward motion of tibia
hand Modification 5
(+)ACL injury = “mushy” or soft end feel
when the tibia is moved forward on the femur
Lachman modification 1

Patient: lie supine while the examiner stands beside the leg to
be tested with the eyes level with the knee.
PT: The examiner grasps the femur with one hand and the tibia
with the other hand. The tibia is pulled forward.
Patient: Sitting with the leg over the edge of the examining
(+)ACL injury = Abnormal forward motion of tibia
table
prone Lachman test (modification 6)
PT: The examiner sits facing the patient and supports the foot
of the test leg on the examiner’s thigh so that the patient’s
knee is flexed 30°. The examiner stabilizes the thigh with one
hand and pulls the tibia forward with the other hand
(+)ACL injury = Abnormal forward motion
Patient: prone
PT: examiner stabilizes the foot between the examiner’s thorax Patient: supine with hips(45) and knees(90) flexed
and arm and places one hand around the tibia. The other hand PT: gently sit on the foot of the patient and palpate
stabilizes the femur.
(+)ACL injury = Abnormal forward motion of tibia
the joint line with the thumbs and grasp the calf of
the px; try to move the tibia anteriorly
(+)ACL injury = tibia translates anteriorly more than
active (no touch) Lachman test (modification 6mm and soft end feel.
7) Finocchieto Jumping sign / jump sign

Patient: supine with the knee over the examiner’s

forearm so that the knee is flexed approximately 30° Patient: supine with knee 140 flexion and fixated
PT: ask the patient to actively extend the knee, and PT: pull the tibia anteriorly aggressively
the examiner watches for anterior displacement of (+)Meniscal tear = examiner feels a jump
the tibia relative to the unaffected side. Posterior Drawer Test
(+)ACL injury = Abnormal forward motion of tibia
Maximum quadriceps test (modification 8)

Patient: supine with hips(45) and knees(90) flexed

Patient: : supine with the knee over the examiner’s PT: stabilize the leg by sitting over the foot. Palpate
forearm so that the knee is flexed approximately 30° the joint line or the tibial plateau. Thumbs placed at
PT: the foot is held down on the table to increase the the tibial tuberosity. Push the tibia posteriorly
pull of the quadriceps (+)PCL injury = excessive posterior translation of tibia
(+)ACL injury = Abnormal forward motion of tibia Active Drawer test or Quadriceps active test Muller’s
test

Anterior drawer test

Patient: supine with hips(45) and knees(90) flexed

PT: hold the patient’s foot down. The patient is
asked to try to straighten the leg, and the examiner
prevents the patient from doing so (isometric test).
(+)ACL disruption = If there is no posterior sag
present and if the tibia shifts forward more on the
injured side than the noninjured side
(+)PCL injury = posterior sag is evident before the
patient contracts the quadriceps.
Patient: lies prone with the knee flexed to 30°
Posterior sag sign (Gravity drawer test) PT: grasps the tibia with one hand while fixing the femur with
the other hand. The examiner then pulls the tibia up
(posteriorly), noting the amount of movement and the quality
of the end feel.
(+)PCL injury = abnormal translation of tibia
Dial Test

Patient: Supine with the hip flexed to 45° and the

knee flexed to 90°.
PT: observe if the tibia translates posteriorly.
(+)PCL injury = when the px extends the knee while the
examiner holds the hip in 90° to 100° of flexion, the tibial
plateau moves or shifts forward to its normal position

Patient: supine or prone position

PT: places one hand behind the posterior proximal tibia to
support the tibia and maintain it in the reduced (normal)
position. The examiner then flexes the knee to 30°, extends the
Godfrey test foot over the side of the examining table, and stabilizes the
femur on the table. The examiner then laterally rotates the
tibia on the femur and compares the amount of rotation with
that on the good side. If the test is done in supine position, the
examiner can observe the amount of tibial tubercle movement
and compare. The test is then repeated with the knee flexed to
90° and the thigh still on the examining table.
(+)isolated posterolateral (popliteus corner) injury = tibia
rotates less at 90° than at 30°
(+)popliteus corner and posterior cruciate injury= knee rotates
more at 90°
(+) mcl injury = pain over the medial knee
Abduction (Valgus stress) test
Patient: supine with the hip flexed to 45° and the
knee flexed to 90°
PT: manual posterior pressure is applied to the tibia,
posterior displacement may increase.
(+)posterior instability = posterior sag sign
Reverse lachman test Patient: supine
PT: The examiner applies a valgus stress (pushes the
knee medially) at the knee while the ankle is
stabilized in slight lateral rotation either with the
hand or with the leg held between the examiner’s
arm and trunk. The knee is first in full extension, and (+)LCL tear = knee joint adducts greater than normal (compared
then it is slightly flexed (20° to 30°) so that it is to the unaffected leg)
Hughston’s varus stress test
unlocked.
(+)MCL injury = gapping or medial joint pain
Note: This may also indicate capsular or cruciate
ligament laxity, depending on what degree of knee
flexion the test is performed at.

Patient: supine
PT: the examiner grasps the fifth and fourth toes and applies a
varus stress to the knee in extension and slightly (20° to 30°)
Hughston’s valgus stress test flexed.
(+)injury to Fibular or lateral collateral ligament, Posterolateral
capsule, Arcuate-popliteus complex, Biceps femoris tendon,
Posterior cruciate ligament, Anterior cruciate ligament, Lateral
gastrocnemius muscle, Iliotibial band = If the test is positive
(i.e., the tibia moves away fromthe femur when a varus stress
is applied) in extension
(+)injury to Lateral collateral ligament, Posterolateral capsule,
Patient: supine Arcuate-popliteus complex, Iliotibial band, Biceps femoris
PT: the examiner faces the patient’s foot, placing his or her tendon= If the test is positive when the knee is flexed 20° to
body against the patient’s thigh to help stabilize the upper leg 30° with lateral rotation of the tibia
in combination with one hand, which can also palpate the joint Mcmurray’s test
line. With the other hand, the examiner grasps the patient’s big
toe and applies a valgus stress, allowing any natural rotation of
the tibia
(+)MCL injury = gapping or medial joint pain
More specific positive findings yung sa baba
(+)MCL injury, Posterior oblique ligament, Posteromedial
capsule, Anterior cruciate ligament, Posterior cruciate ligament,
Medial quadriceps expansion, Semimembranosus muscle = the
tibia moves away from the femur an excessive Patient: supine with test knee fully flexed
amount when a valgus stress is applied) when the PT: for lateral meniscus, rotate the tibia medially, then bring
knee is in extension the knee to extension. Repeat with a different angle of knee
flexion
(+)Medial collateral ligament,Posterior oblique
For medial meniscus, externally rotate the tibia, then bring the
ligament, Posterior cruciate ligament, Posteromedial knee to full flexion
capsule = If the test is positive when the knee is (+)meniscal damage = clicking, locking, or pain
flexed to 20° to 30°
Varus stress test

Appley’s test

Patient: supine
PT: examiner applies a varus stress (pushes the knee laterally)
at the knee while the ankle is stabilized. The test is first done
with the knee in full extension and then with the knee in 20° to
30° of flexion. If the tibia is laterally rotated in full extension Patient: prone
before the test, the cruciate ligaments are uncoiled, and PT: fixate the test leg with own leg, bring the knee to 90 deg of
maximum stress is placed on the collateral ligaments flexion. add lateral and medial roation of the tibia. Note for
excessive rotation. Then add compression
(+) meniscal damage = pain during rotation and compression,
decrease in rotation
(+) ligamentous damage= pain on rotation and distraction,
increase in rotation
Thessaly test

Patient: stand on the injured leg with knees flexed at 20

PT: ask the px to rotate on the tibia 3 times
(+)meniscal damage= pain during rotation
Bounce home test
Patient: supine
PT: cup the patient’s foot. Leg completely flexed, then allow it
to passively extend, the knee should bounce back with a sharp
end point.
(+)meniscus damage = rubbery end feel, does not bounce, joint
line pain
(+)intraartciular fragments= hard end feel

Ege’s test

Patient: standing with fully extended knees, feet 40 cm apart

PT: medial meniscus, ask the px to squat with legs in maximal
ER. Distance between knees increases and each knee becomes
externally rotated as the squatting proceeds.
Lateral meniscus, both LE are in IR while the px squats and
stands up. Distance between the knees decreases and knees
become IRed as squatting proceeds.
(+)meniscal tear = pain, click is felt, and/or pain when the px
stands up