Knee Orthopaedic Test: Apley's Test

Apley's test of the knee is a physical exam technique used to evaluate for meniscal tears in the knee joint. It is performed by a healthcare professional and involves applying pressure to the knee joint while the knee is flexed and extended.

Here is a step-by-step procedure for performing Apley's test:

1. The patient should lie prone on an examination table with the affected knee flexed to 90 degrees.
2. The examiner should stand at the patient's foot, grasp the ankle with one hand, and apply downward traction to the leg.
3. With the other hand, the examiner should rotate the leg internally and externally while maintaining downward traction.
4. The examiner should ask the patient to report any pain or discomfort during the rotation.
5. The examiner should repeat the procedure while applying pressure to the lateral side of the knee to test the medial meniscus and vice versa to test the lateral meniscus.
6. The examiner should compare the results to the unaffected knee.

If there is pain or discomfort during rotation, this may indicate a meniscal tear. However, further diagnostic testing, such as MRI or arthroscopy, may be necessary to confirm the diagnosis.

References:

1. Apley, G. A. (1947). The diagnosis of meniscus injuries and the torn meniscus. British journal of surgery, 35(141), 200-208.
2. Magee, D. J. (2013). Orthopedic physical assessment (6th ed.). St. Louis, MO: Saunders/Elsevier.
3. Dutton, M. (2012). Orthopaedic examination, evaluation, and intervention (3rd ed.). New York, NY: McGraw-Hill Medical.
4. Anderson, A. F., & Irrgang, J. J. (2001). Meniscal repair: Scientific rationale, surgical techniques, and clinical efficacy. Journal of orthopaedic and sports physical therapy, 31(6), 315-331.
5. Arshi, A., Cohen, J. R., Wang, J. C., Hame, S. L., & McAllister, D. R. (2014). Diagnostic accuracy of 3 physical examination tests in the assessment of meniscal tears of the knee. The American journal of sports medicine, 42(4), 906-911.
6. Katz, J. N., Brophy, R. H., Chaisson, C. E., de Chaves, L., Cole, B. J., Dahm, D. L., ... & Martin, S. D. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine, 368(18), 1675-1684.
7. Konan, S., Rayan, F., & Haddad, F. S. (2012). A clinical review of the assessment of meniscal tears. The surgeon, 10(1), 43-48.