Physical Examination 215: The Knee

The knee, and only the knee, taken test by test on video. It opens with the anatomy — bones, cartilage, synovium, the four major ligaments, the menisci and their blood supply — and the Q-angle with its normal values and abnormal threshold, then the consultation. The examination runs through the patellofemoral joint (patellar apprehension, the circle sign, Clarke's grind test, the Helfet screw-home test), osteochondritis dissecans (Wilson's test) and fat pad impingement (Hoffa's test), the iliotibial band (Ober's, modified Ober's, Noble compression), the menisci (joint-line palpation, McMurray's for each meniscus, Apley's compression and distraction, Payr's, bounce home, Thessaly, Ege's and the duck walk), and the four ligaments: Lachman's, anterior drawer and pivot shift for the ACL; posterior drawer, posterior sag and the quadriceps active test for the PCL; valgus stress for the MCL and posteromedial corner; varus stress for the LCL.

Donald Ozello, DC, CCN, CCSM — sports chiropractor and NSCA Certified Personal Trainer — teaches the 2-hour course. It is written for Doctors of Chiropractic who want a complete, repeatable knee examination: the weekend athlete who heard a pop, the runner with lateral knee pain at thirty degrees, the patient whose knee locks or gives way. Each test is shown on video with the patient and doctor positions, the hand placements, the positive finding and what it indicates.

By which way the tibia moves and what the endpoint feels like, and the course spends four tests on each ligament. For the ACL, Lachman's test is the workhorse — the knee held between twenty and thirty degrees, one hand on the distal femur and the other pulling the proximal tibia forward — and the finding is increased anterior translation compared with the other side; a soft endpoint is highly predictive of rupture, a hard stop suggests an intact ligament even with extra translation, and the test is especially useful in the first days after injury when the knee is swollen and painful. The anterior drawer test repeats the pull at ninety degrees in neutral, internal and external rotation, and the pivot shift test reproduces the rotatory instability — a slight, uncomfortable shift with an isolated ACL rupture, a large visible jerk only when the posterolateral corner is involved. For the PCL the direction reverses: the posterior drawer test looks for increased posterior translation with a soft endpoint, the posterior sag test compares the resting position of the two tibiae with hips and knees at ninety degrees, and the quadriceps active test resolves the ambiguity — if the tibia starts sagged and shifts forward on quadriceps contraction, the PCL is injured; if there was no sag to begin with, an anterior shift points to the ACL.

Physical Examination 215 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.

Physical Examination 206: Knee and Lower Leg, Dr. O'Hara's course that runs from the ankle up and covers the knee's headline tests, so the two together give the whole lower leg; and Dr. Ozello's 208: Lumbar Spine & Sacroiliac Joints for the rest of the lower quarter. Any three Physical Examination courses are 6 CE hours, where the automatic 10% multi-course discount starts ($108 instead of $120), and Dr. Ozello's eight regional titles together are 16 CE hours at the 20% tier ($256 instead of $320). New Physical Examination titles are released as faculty complete them; the current list with pricing lives on the category page.