During the passive movement examination of the knee flexion and extension are always tested, even if these were not impaired during the active movement examination. The only physical-diagnostic finding for some knee abnormalities may be palpable crepitations (retropatellar chondropathy). Therefore, endorotation and exorotation are only tested in the passive examination (meniscus injuries).
Procedure
The patient lies completely flat with extended hips and knees (if possible).
Test:
- For flexion [Figure 59] and extension [Figure 60], palpate the knee with one hand, during which the thumb palpates one side of the joint space and the index or middle finger palpates on the other side of the joint space.
- To locate the joint space, the knee can best be briefly brought into 90° flexion.
- During this palpation, the palm of the hand should rest gently on the patella.
- The common hand should be placed around the ankle or the calcaneus of the leg concerned.
- If abnormal lateralisation was observed during the active movement examination, it might be worthwhile to perform this palpation again, while loosely palpating the patella between the thumb and index finger. This way, you might be able to objectify the ‘poor tracking’ of the patella. However, international literature does not state when this lateralisation should be considered abnormal.
Figure 59
Figure 60
- For exorotation [Figure 61] and endorotation [Figure 62], the grip is the same as described above.
- Use your hand (placed around the calcaneus) to rotate the leg (that is held in 90° flexion) first outwards (exorotation), then inwards (endorotation).
- Note any indication of pain (meniscal damage).
Figure 61
Figure 62
While making these movements assess once again:
- Course of movement.
- Maximum range of motion.
- Occurrence of pain.
- Presence or disappearance of crepitations.
- If you do not observe any abnormalities, the movement examination of the hip should be performed next.
- Knee complaints may be due to referred pain and this is especially the case in children.