ROTATORY INSTABILITIES SPECIAL TESTS

TESTS FOR ONE-PLANE ANTERIOR INSTABLITY

PT Position sitting on the patient’s forefoot

Pt Position knee is flexed to 90°, and the hip is flexed to 45°.
PT holds the patient’s foot down. The patient is asked to try to
Procedures
straighten the leg, and the PT prevents pt from doing so.
no posterior sag present and if the tibia shifts forward more on the
Positive SIgn
injured side than the noninjured side
Indicative Of: ACL Disruption

PT Position sitting on the patient’s forefoot

Pt Position knee is flexed to 90°, and the hip is flexed to 45°.
pt’s foot is held on the table by the PT’s body and the foot in
neutral rotation. The PT’s hands are placed around the tibia to
Procedures
ensure that the hamstring muscles are relaxed, then tibia is then
drawn forward on the femur
Positive SIgn the tibia moves forward more than 6 mm on the femur),

Pt. lies supine with the involved leg beside the examiner. PT holds
Classic
the pt’s knee between full extension and 30° of flexion.
mushy” or soft end feel (tibia is moved forward on the femur
Positive sign (increased anterior translation with medial rotation of the tibia)
disappearance of the infrapatellar tendon slope.
Pt. sitting with the leg over the edge of the examining table. PT
sits facing the pt. and supports the foot of the test leg on the PT’s
Modification 1
thigh so that the pt’s knee is flexed 30°. PT stabilizes the thigh
withone hand and pulls the tibia forward with the other hand

Positive Sign Abnormal forward motion

Modification 2 PT with small hands The pt lies supine with the knee resting on the
( stable
PT’s knee. One of the PT’s hands stabilizes the femur against the PT
Lachman
’s thigh, and the other hand applies an anterior stress
Test)

Pt lies supine, leg to be examined is abducted off the side of the

examining table and the knee is flexed to 25°. One hand of PT
Modification 3
stabilizes the femur against the table while the pt’s foot is held
(Drop Leg)
between PT’s knees. The PT’s other hand is then free to apply the
anterior translation force

Pt in supine while PT stabilizes the foot between the PT’s

thorax and arm. Both hands are placed around the tibia,
Modification 4
the knee is flexed 20° to 30°, and an anterior drawer
movement is performed.

Pt lie supine while the PT stands beside leg to be tested with the
Modification 5 eyes level with the knee. The PT grasps the femur with one hand
and the tibia with the other hand. The tibia is pulled forward.
Modification 6 Pt lies prone, and PT stabilizes the foot between the PT’s thorax
( prone and arm and places one hand around the tibia. The other hand
Lachman test ) stabilizes the femur

PT lies supine with the knee over the PT’s forearm so that the knee
Modification 7
is flexed approximately 30°. Pt. is asked to actively extend the knee,
( active (no
and PT watches for anterior displacement of the tibia relative to
touch)
the unaffected side.

Modification 8 pt is asked to actively extend the knee, and PT watches for

(active anterior displacement of the tibia relative to the unaffected side.
maximum The test may also be carried out with the foot held down on the
quadriceps) table to increase the pull of the quadriceps.

Tests for One-Plane Posterior Instability

Procedure Check Drawer Sign ( In this part of the test, the tibia is pushed back
on the femur.)

PT Position
Pt Position supine with the hip flexed to 45° and the knee flexed to 90°.
Procedure
Positive Sign tibia “drops back,” or sags back

PT Position
Pt Position supine
Procedure PT holds both legs while flexing the patient’s hips and knees to 90°
Positive Sign posterior sag of the tibia

PT Position holds the patient’s foot down

Pt Position knee is flexed to 90°, and the hip is flexed to 45°.
Procedure pt is asked to try to straighten the leg, and the PT prevents the
patient from doing so
Positive Sign Posterior sag
Test for One-Plane Lateral Instability

PT Position
Pt Position knee in full extension and then with the knee in 20° to 30° of
flexion
Procedure PT applies a varus stress (pushes the knee laterally) at the knee
while the ankle is stabilized
Positive Sign the tibia moves away from the femur when a varus stress is applied
Test for One-Plane Medial Instability

PT Position
Pt Position knee is first in full extension, and then it is slightly flexed (20° to
30°) so that it is “unlocked
Procedure PT applies a valgus stress (pushes the knee medially) at the knee
while ankle is stabilized in slight lateral rotation either with the
hand or with the leg held between the PT’s arm and trunk.
Positive Sign tibia moves away from femur an excessive amount when a valgus
stress is applied) when the knee is in extension
Tests for Anteromedial Rotary Instability

PT Position
Pt Position supine
PT holds the patient’s leg with one arm against the body hand
Procedure under the calf to lift the tibia while applying a valgus stress. The
other hand pushes the femur down
If the knee is then flexed, the tibial plateau reduces suddenly, jolt
Positive Sign
is painful

PT Position
knee is flexed to 80° or 90°, and the hip is flexed to 45°. Foot is first
Pt Position
placed in 30° medial rotation
PT then sits on the pt’s forefoot to hold the foot in position
Procedure
and draws the tibia forward;
Positive Sign Movement occurs primarily on the lateral side of the knee.

PT Position
Pt Position foot is placed in 15° of lateral rotation,
Procedure the tibia is drawn forward by PT
Positive Sign movement occurs primarily on the medial side of the knee.
Tests for Anterolateral Rotary Instability
1. Active Pivot Shift Test.
PT Position
Pt Position sits with foot on the floor in neutral rotation and knee flexed 80° to
90° patient’s hip is flexed to 45°.
Procedure pt isometrically contract the quadriceps, PT stabilizes the foot.
Positive Sign anterolateral subluxation of the lateral tibial plateau
2. Jerk Test of Hughston
PT Position
sits with foot on the floor in neutral rotation and knee flexed 80° to
Pt Position
90°, hip is flexed to 45°.
Knee is first flexed to 90°. Leg is then extended, maintaining medial
Procedure
rotation and a valgus stress
Positive Sign anterolateral subluxation of the lateral tibial plateau with a jerk
3. Losee Test.
PT holds the patient’s ankle and foot so that the leg is laterally
PT Position
rotated.
Pt Position The knee is flexed to 30
With PT’s other hand positioned so that the fingers lie over the
Procedure
patella and the thumb is hooked behind the fibular head, a valgus
 force is applied to the knee; PT can use the abdomen as a fulcrum
while extending the pat’s knee and applying forward pressure
behind the fibular head with the thumb.
Positive Sign Just before full extension of the knee, there is a “clunk” forward
Tests for Posterolateral Rotary Instability

PT Position
Pt Position pt’s foot is slightly laterally rotated.
Procedure Knee is first flexed to 90°. Leg is then extended, maintaining medial
rotation and a valgus stress
Positive Sign anterolateral subluxation of the lateral tibial plateau with a jerk

PT Position
supine with the knee flexed to 80° to 90° and the hip flexed to 45.
Pt Position
foot is slightly laterally rotated.
PT laterally rotates the pt’s foot slightly and sits on the foot to
Procedure
stabilize it. The PT then pushes the tibia posteriorly.
the tibia rotates posteriorly on the lateral side an excessive amount
Positive Sign relative to the uninvolved leg when the examiner pushes the tibia
posteriorly

faces the patient and lifts the pt’s leg, and supports leg against the
PT Position PT’s pelvis. The PT’s other hand supports the lateral side of the calf
with the palm on the proximal fibula.
stands and leans against a lies in the supine position with the
wall with uninjured side hamstring muscles relaxed. The
Pt Position adjacent to the wall & body knee is flexed to 70° to 80° of
wt. distributed flexion, and the foot is laterally
equally between two feet rotated
PT’s hands are placed above knee is taken into extension by its
and below the involved own weight while the PT leans on
knee, and a valgus stress is the foot to impart a valgus stress to
Procedure exerted while flexion of the the knee through the leg. Leg is
pt’s knee is initiated. then flexed again, and the foot falls
back into lateral rotation and
posterior subluxation.
jerk in the knee or the tibia Knee approaches 20° of flexion, the
shifts posteriorly and the lateral tibial tubercle shifts forward
Positive Sign
“giving way” or anteriorly into the neutral
rotation & reduces the subluxation
Tests for Posteromedial Rotary Instability

PT Position
Pt Position supine with the knee flexed to 80° to 90° and the hip flexed to 45°
The PT medially rotates the pt’s foot slightly and sits on the foot to
Procedure
stabilize it, then pushes the tibia posteriorly.
the tibia moves or rotates posteriorly on the medial aspect an
Positive Sign
excessive amount relative to the normal knee

PT Position
Pt Position Lies relaxed in the supine position.
PT passively flexes the knee more than 45° while applying a varus
Procedure
stress, compression, and medial rotation of the tibia; in a “positive”
 knee. The examiner then takes the knee into extension.
At about 20° to 40° of flexion, the tibia shifts into the reduced
Positive Sign position

Tests for Meniscus Injury

PT Position
prone position with the knee flexed to 90°. The pt’s thigh is then
Pt Position
anchored to the ex table with the PT’s knee
PT medially and laterally rot. tibia, combined first with distraction,
Procedure while noting any restriction, excessive movement, or discomfort. Then
the process is repeated using compression instead of distraction.
Ligamentous = rotation plus distraction is more
painful or shows increased rotation relative to the normal side,
Positive Sign
Meniscal Injury= rot. plus compression is more painful or shows
decreased rotation relative to the normal side

PT Position
Pt Position supine position with the knee completely flexed (the heel to the buttock)
Procedure PT then medially rotates the tibia and extends the knee

Positive snap or click that is often accompanied by pain.

Sign

PT Position
Pt Position Supine and the heel of the patient’s foot is cupped in PT’s hand
Procedure The pt’s knee is completely flexed, and the knee is passively allowed to
extend.
Positive extension is not complete or has a rubbery end feel (“springy block”),
Sign

PT Position
Pt Position stands with the knees in extension and the feet 30 to 40 cm (11 to 15
inches) away from each other.
Procedure To test the medial meniscus, pt To test the lateral meniscus,
laterally rotates each tibia maximally both tibias are medially
and squats causing the distance rotated maximally while the
between the knees and lateral rotation patient squats and then
to increase. The pt then stands slowly stands up).
while leaving the feet laterally rotated.
Positive Sign pain &/or a click is felt by the pt along the jt line/ heard by the PT.

PT Position provides his or her hands for balance

Pt Position stands flat footed on one leg
Procedure pt then flexes the knee to 5° and rotates the femur on the tibia
medially and laterally three times while maintaining the 5° flexion.
(The good leg is tested first, and then the injured leg. The test is then
repeated at 20° flexion
Positive Sign Pt experiences medial or lateral joint line discomfort.
Tests for Ligamentous Instability

PT Position stabilizes the tibia and fibula,

Pt Position supine with the foot relaxed
holds the pt’s foot in 20° of plantar flexion, and draws the talus
Procedure forward in the ankle mortise
Straight anterior movement or translation occurs, the test indicates
Positive Sign both medial and lateral ligament insufficiencies.

PT Position stabilizes the leg with one hand

seated with the leg hanging over the examining table with the knee
Pt Position at 90°.
With the other hand, PT holds the foot in plantigrade (90°) and
Procedure applies a passive lateral rotation stress to the foot and ankle.
Syndesmosis (high ankle) injury = pain is produced
over the anterior or posterior tibiofibular ligaments and
Positive Sign the interosseous membrane
Deltoid Lig. Tear = pain medially and the examiner feels the talus
displace from the medial malleolus,

PT Position
Pt Position supine or side lying position with the foot relaxed
The foot is held in the anatomical (90°) position, which brings the
calcaneofibular ligament perpendicular to the long axis of the talus.
The talus is then tilted from side to side into inversion and eversion.
Inversion tests the calcaneofibular ligament and, to some
Procedure degree, the anterior talofibular ligament by increasing the
stress on the ligament. Eversion stresses the deltoid ligament,
primarily the tibionavicular, tibiocalcaneal, and posterior tibiotalar
ligaments.
Positive Sign