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🦵Assessing the Knee — Clinical Tests and Red Flags

Knee · The knee is the body's largest joint and one of its most frequently injured, relying on ligaments and surrounding muscles rather than bony shape for stability.

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Quick answers

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome describes pain around or behind the kneecap, often related to how the kneecap tracks in its groove during bending movements, and is common among runners and young active individuals.

What is the difference between the meniscus and the ACL?

The menisci are C-shaped cartilage cushions that absorb shock between the thigh and shin bones, while the anterior cruciate ligament (ACL) is one of several ligaments that control the knee's stability during rotation and forward sliding of the shin bone.

Does every meniscus tear need surgery?

Many meniscus tears, particularly smaller or degenerative tears in middle-aged and older adults, are managed successfully with exercise-based rehabilitation, while larger or mechanically unstable tears may be considered for surgical repair.

Is running bad for the knees?

Current evidence generally does not support the idea that recreational running increases the risk of knee osteoarthritis, and moderate running is often considered compatible with long-term joint health for most people.

What does a 'locked knee' mean?

A locked knee refers to an inability to fully bend or straighten the joint, often due to a displaced piece of torn meniscus or loose cartilage fragment, and typically warrants prompt evaluation.

How common is knee osteoarthritis?

Knee osteoarthritis is among the most common joint conditions affecting older adults, with prevalence increasing steadily with age and additional risk associated with prior injury and higher body weight.

Start with this section - Tests & assessment

Knee assessment typically begins with a history of onset, mechanism of injury if applicable, and pain location, followed by observation of swelling, alignment, and active range of motion.

A battery of special tests then helps assess ligament stability, meniscus integrity, and patellofemoral mechanics, guiding whether further imaging or referral is warranted.

Assessment tests

Assess ACL integrity

Lachman test

With the knee slightly bent, the examiner assesses forward translation of the shin bone relative to the thigh bone to evaluate the anterior cruciate ligament.

Detect meniscus tears

McMurray test

Combining knee rotation with bending and straightening while palpating the joint line can reproduce clicking or pain associated with a meniscus tear.

Assess patellofemoral pain

Patellar grind (compression) test

Gently compressing the kneecap against the thigh bone during a slight contraction can reproduce pain typical of patellofemoral pain syndrome.

Assess collateral ligament stability

Valgus and varus stress tests

Applying gentle sideways stress to the knee at slight bending evaluates the integrity of the inner and outer collateral ligaments.

Assess movement quality and control

Functional single-leg squat

Observing alignment and control during a single-leg squat helps identify movement patterns, such as excessive inward knee collapse, relevant to several overuse conditions.

Warning signs

These warrant prompt clinical review rather than unsupervised exercise progression.

Inability to bear weight after injury

A sudden inability to bear weight following a twisting or impact injury raises concern for fracture or significant ligament injury and warrants urgent evaluation.

Locked knee

An inability to fully bend or straighten the knee, often due to a displaced meniscus fragment or loose body, typically requires prompt evaluation.

Significant, rapid swelling after injury

Marked swelling developing within hours of an injury can indicate a significant internal injury such as a ligament tear and warrants assessment.

Signs of infection

Warmth, redness, and fever around the knee raise concern for septic arthritis, a medical emergency requiring urgent care.

This combination of history, special tests, and functional assessment allows clinicians to distinguish between the knee's many possible sources of pain and determine whether imaging or specialist referral is warranted.

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