PFJ Exam

Look

 

Stigmata Generalised disease

- Marfan's

 

Ligamentous laxity Wynne Davies

- positive if 3/5 pairs

- thumb touches volar forearm

- fingers parallel to forearm dorsally

- elbow hyperextends past 0o

- knee hyperextends past 0o

- ankle dorsiflexes > 45o

 

Front

 

VMO bulk

Swelling

Scars of previous surgery i.e. TTT

 

Planovalgus Feet / Hyperpronation

 

Genu Valgum

 

Squinting patella 

- Proximal Femoral Anteversion  (PFA)

- patellae point inwards when standing

 

Grasshopper eyes 

- patellas sit high & lateral

- due to patella alta 

- patella subluxed laterally 

 

Side

 

Flexed attitude Knee

Scars

 

Back

 

Level Popliteal creases

Valgus Heels

 

Gait 

 

Foot Progression Angle

- Normal 10° (0-30°)

- any in-toeing

- indicative of PFA

 

Sit on ege of Bed

 

Patella Tracking

- J sign

- lateral subluxation in terminal extension

 

Crepitus

 

Supine

 

Effusion

 

3 signs in Extension

 

1.  Tenderness

- tibial tuberosity

- lateral patella retinaculum

- patella

- Bassett's sign (MPFL on med epicondyle)

- pain with patella grind (compression)

 

2.  Clark's test

- gentle pressure on superior pole

- patient asked to contract quadriceps

- compare with other side

 

3.  Patellar Tilt Test

- Patient supine and relaxed with knees extended

- Trans- epicondylar axis placed parallel to table

- Lateral edge of patella elevated & medial edge depressed

- normal is lateral tilt 0-20°

- Abnormal if unable to tilt to horizontal

- indicated lateral retinaculum tightness

 

3 Signs in 30o Flexion

 

1.  Q angle 

- Knee at 30° flexion so patella engages femoral sulcus

- ASIS to centre of patella to tibial tuberosity

- abnormal > 15° in males 

- abnormal > 20° in female

 

2.  Patellar glide test (Sage Mobility)

-  Graded by number of 1/4 widths that patella displaces

- > 3 insufficient medial restraints

- < 1 tight lateral retinaculum

- > 3 insufficient lateral restraints

 

3.  Apprehension test

- patient supine and relaxed

- patella pushed laterally while knee flexed 30o

- positive if patient uncomfortable (pain or apprehension)

 

Prone / Rotational profile

 

Best is all assessed prone

 

1.  Lateral border of foot

- metatarsus adductus

 

2.  Tibial Torsion

- thigh foot angle > 15o

- trans-malleolar axis > 30o

 

3.  Femoral anteversion 

- excessive IR

- increased Gage's trochanteric angle