Knee Orthopaedic Test: Moving Patellar Apprehension Test

The Moving Patellar Apprehension Test is a physical exam maneuver used to evaluate for instability of the patella (kneecap). It is used to diagnose patellofemoral instability and patellar subluxation or dislocation. 

Here are the steps to perform the Moving Patellar Apprehension Test:

1. The patient lies supine (on their back) on an examination table with their knee extended.
2. The examiner places their hand on the patient's knee with their fingers around the medial (inner) border of the patella.
3. The examiner gently pushes the patella laterally (towards the outside of the knee) while the knee is in full extension.
4. The examiner then flexes the knee to 20-30 degrees while maintaining lateral pressure on the patella.
5. While maintaining lateral pressure on the patella, the examiner then externally rotates the tibia (lower leg bone) by turning the patient's foot outward.
6. The examiner slowly extends the knee while observing for any patellar subluxation (partial dislocation) or dislocation.
7. If the patient experiences apprehension (fear or discomfort) during this maneuver, the test is considered positive for patellar instability.

References:

1. Magee DJ. Orthopedic Physical Assessment. Elsevier Health Sciences, 2013.
2. Hoppenfeld S, deBoer P. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lippincott Williams & Wilkins, 2016.
3. Lee TQ, Black AD, Tibone JE, McMahon PJ. The Fick-Knee: Biomechanical Analysis of the Knee Under Compressive Load. J Orthop Sports Phys Ther. 2002;32(4):141-146.
4. Paluska SA. An Overview of Knee Injuries in the Young Athlete. Pediatrics in Review. 2006;27(9):e62-e73.