Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Knee


Clinical Summary and Recommendations

Patient History
Complaints

  • Little is known about the utility of subjective complaints with knee pain.

  • The absence of “weight bearing during trauma” may help rule out a meniscal tear (likelihood ratio [LR] = .40).

  • Symptoms in combination with examination findings may be optimized to identify patients at increased risk of knee joint effusion. Self-noticed knee swelling in combination with self-reported pain with leg straightening may help in ruling in the presence of medium/large knee joint effusion (+LR = 2.9 to 9.7).

Physical Examination
Screening

  • The Ottawa Knee Rule for Radiography is highly sensitive for knee fractures in both adults and children. When patients are younger than 55 years, can bear weight and flex the knee to 90 degrees, and have no tenderness on the patella or fibular head, providers can confidently rule out a knee fracture (−LR = .05 to .07).

Range-of-Motion and Strength Assessment

  • Measuring knee range of motion has consistently been shown to be highly reliable but is of unknown diagnostic utility. The assessment of “end feel” during range-of-motion measurements, however, is unreliable, especially between different examiners.

  • Assessing strength with manual muscle testing has been shown to accurately detect side-to-side knee extension strength deficits, at least in patients in an acute rehabilitation hospital setting.

Special Tests

  • Several systematic reviews with metaanalysis have examined special tests of the knee.

  • The Thessaly test, McMurray test, and “joint line tenderness” consistently show moderate utility in detecting and ruling out meniscal tears.

  • Although the anterior drawer test and pivot shift test are good at identifying anterior cruciate ligament (ACL) tears (+LR = 1.5 to 36.5), the Lachman test is best at ruling them out (−LR = .10 to .24).

  • Varus and valgus testing, while not particularly reliable, is fairly good at ruling out medial collateral ligament (MCL) tears (−LR = .20 to .30).

  • The “moving patellar apprehension test” seems to show very good diagnostic utility in both identifying and ruling out patellar instability (+LR = 8.3, −LR = .00).

Combinations of Findings

  • Generally, the clinical examination and/or combinations of findings seem to be very good at identifying and ruling out various knee pathologic conditions, including meniscal tears, ACL tears, and symptomatic plica.

  • Presence of joint line tenderness and a positive McMurray test seems to show good diagnostic utility in both identifying and ruling out meniscal tears (+LR = 10.1 to 75, −LR = .10 to .25).

  • Presence of joint line tenderness and a positive Thessaly test also seems to show good diagnostic utility in both identifying and ruling out meniscal tears (+LR = 11.6 to 78, −LR = .08 to .22).

  • Clinical prediction rules for both identifying and ruling out symptomatic meniscal tear (+LR = 3.99 to 10.39, −LR = .03 to .31), patellofemoral pain (+LR = 5.2 to 14.58, −LR = .06 to .27), and knee osteoarthritis (+LR = 6.53 to 28.41, −LR = .06 to .20) have been developed and show good initial diagnostic utility.

Interventions

  • In patients with patellofemoral pain syndrome, a combination of factors (age over 25 years, height less than 65 inches, worst pain visual analog scale less than 53 mm, and a difference in midfoot width from non−weight bearing to weight bearing of more than 11 mm) seems to predict a favorable response to foot orthoses (+LR = 8.8 if three of four factors present).

  • Similarly, several factors have been identified that predict which patients with knee osteoarthritis (OA) may benefit from hip mobilizations.

Anatomy

Osteology

Arthrology

Figure 7-1, Femur.

Figure 7-2, Tibia and fibula.

Figure 7-3, Sagittal knee.

Joints Type and Classification Closed Packed Position Capsular Pattern
Tibiofemoral Double condyloid Full extension Flexion restricted greater than extension
Proximal tibiofibular Synovial: plane Not reported Not reported
Patellofemoral Synovial: plane Full flexion Not reported

Ligaments

Figure 7-4, Posterior ligaments of knee.

Ligaments Attachments Function
Posterior meniscofemoral Lateral meniscus to posterior cruciate ligament (PCL) and medial femoral condyle Reinforces posterior lateral meniscal attachment
Oblique popliteal Posterior aspect of medial tibial condyle to posterior aspect of fibrous capsule Strengthens posterior portion of joint capsule
Arcuate popliteal Posterior fibular head over tendon of popliteus to posterior capsule Strengthens posterior portion of joint capsule
Posterior ligament of fibular head Posterior fibular head to inferior lateral tibial condyle Reinforces posterior joint capsule
Anterior cruciate Anterior intracondylar aspect of tibial plateau to posteromedial side of lateral femoral condyle Prevents posterior translation of femur on tibia and anterior translation of tibia on femur
Posterior cruciate Posterior intracondylar aspect of tibial plateau to anterolateral side of medial femoral condyle Prevents anterior translation of femur on tibia and posterior translation of tibia on femur
Fibular collateral Lateral epicondyle of femur to lateral aspect of fibular head Protects joint from varus stress
Tibial collateral Femoral medial epicondyle to medial condyle of tibia Protects the joint from valgus stress
Transverse ligament of knee Anterior edges of menisci Allows menisci to move together during knee movement

Figure 7-5, Posterior ligaments of knee (continued).

Figure 7-6, Inferior, anterior, and superior views of ligaments of knee.

Muscles

Muscles Proximal Attachments Distal Attachments Nerve and Segmental Level Action
Quadriceps
Rectus femoris 		Anterior inferior iliac spine and ileum just superior to acetabulum Base of patella and by patellar ligament to tibial tuberosity Femoral nerve (L2, L3, L4) Extends knee; rectus femoris also flexes hip and stabilizes head of femur in acetabulum
Vastus lateralis Greater trochanter and linea aspera of femur
Vastus medialis Intertrochanteric line and linea aspera
Vastus intermedius Anterolateral aspect of shaft of femur
Articularis genu Anteroinferior aspect of femur Synovial membrane of knee joint Femoral nerve (L3, L4) Pulls synovial membrane superiorly during knee extension to prevent pinching of membrane
Hamstrings
Semimembranosus 		Ischial tuberosity Medial aspect of superior tibia Tibial branch of sciatic nerve (L4, L5, S1, S2) Flexes and medially rotates knee, extends and medially rotates hip
Semitendinosus Ischial tuberosity Posterior aspect of medial condyle of tibia
Biceps femoris
Short head 		Lateral linea aspera and proximal two thirds of supracondylar line of femur Lateral head of fibula and lateral tibial condyle Fibular branch of sciatic nerve (L5, S1, S2) Flexes and laterally rotates knee
Long head Ischial tuberosity Tibial branch of sciatic nerve (L5, S1-S3) Flexes and laterally rotates knee, extends and laterally rotates hip
Gracilis Body and inferior ramus of pubis Medial aspect of superior tibia Obturator nerve (L2, L3) Adducts hip, flexes and medially rotates knee
Sartorius Anterior superior iliac spine and anterior iliac crest Superomedial aspect of tibia Femoral nerve (L2, L3) Flexes, abducts, and externally rotates hip, flexes knee
Gastrocnemius
Lateral head
Medial head 		Lateral femoral condyle
Superior aspect of medial femoral condyle		 Posterior calcaneus Tibial nerve (S1, S2) Plantarflexes ankle and flexes knee
Popliteus Lateral femoral condyle and lateral meniscus Superior to soleal line on posterior tibia Tibial nerve (L4, L5, S1) Weak knee flexion and unlocking of knee joint
Plantaris Lateral supracondylar line of femur and oblique popliteal ligament Posterior calcaneus Tibial nerve (S1, S2) Weak assist in knee flexion and ankle plantarflexion

Figure 7-7, Anterior and posterior muscles of knee.

Figure 7-8, Lateral and medial muscles of knee.

Figure 7-9, Obturator nerve.

Nerves Segmental Level Sensory Motor
Femoral L2, L3, L4 Thigh via cutaneous nerves Iliacus, sartorius, quadriceps femoris, articularis genu, pectineus
Obturator L2, L3, L4 Medial thigh Adductor longus, adductor brevis, adductor magnus (adductor part), gracilis, obturator externus
Saphenous L2, L3, L4 Medial leg and foot No motor
Tibial nerve L4, L5, S1, S2, S3 Posterior heel and plantar surface of foot Semitendinosus, semimembranosus, biceps femoris, adductor magnus, gastrocnemius, soleus, plantaris, flexor hallucis longus, flexor digitorum longus, tibialis posterior
Common fibular nerve L4, L5, S1, S2 Lateral posterior leg Biceps femoris

Nerves

Figure 7-10, Femoral nerve and lateral femoral cutaneous nerves.

Figure 7-11, Sciatic nerve and posterior femoral cutaneous nerve.

Patient History

Initial Hypotheses Based on Historical Findings

Figure 7-12, Anterior cruciate ligament ruptures.

Patient Reports Initial Hypothesis
Patient reports a traumatic onset of knee pain that occurred during jumping, twisting, or changing directions with foot planted Possible ligamentous injury (ACL) ,
Possible patellar subluxation
Possible quadriceps rupture
Possible meniscal tear
Patient reports traumatic injury that resulted in a posteriorly directed force to tibia with knee flexed Possible PCL injury
Patient reports traumatic injury that resulted in a varus or valgus force exerted on knee Possible collateral ligament injury (lateral collateral ligament [LCL] or MCL)
Patient reports anterior knee pain with jumping and full knee flexion Possible patellar tendinitis ,
Possible patellofemoral pain syndrome ,
Patient reports swelling in knee with occasional locking and clicking Possible meniscal tear
Possible loose body within knee joint
Patient reports pain with prolonged knee flexion, during squats, and while going up and down stairs Possible patellofemoral pain syndrome ,
Patient reports pain and stiffness in morning that diminishes after a few hours Possible OA ,

Assessing Subjective Questions in Patients with Osteoarthritis

Figure 7-13, Osteoarthritis of the knee.

History and Study Quality Population Interexaminer Reliability
Acute injury 152 patients with OA of knee κ = .21 (.03, .39)
Swelling κ = .33 (.17, .49)
Giving way κ = .12 (−.04, .28)
Locking κ = .44 (.26, .62)
Pain, generalized κ = −.03 (.15, .21)
Pain at rest κ = .16 (.00, .32)
Pain rising from chair κ = .25 (.05, .45)
Pain climbing stairs κ = .21 (.06, .48)

Reliability of the Meniscal Symptom Index in Patients with Meniscal Tears

History and Study Quality Population Interexaminer Reliability
Clicking: “Do you feel a clicking sensation or hear a clicking noise when you move your knee?” 30 patients with meniscal tear κ = .80 (.58, 1.0)
Catching: “Do you feel that sometimes something is caught in your knee that momentarily prevents movement?” κ = .65 (.37, .93)
Giving way: “Do you sometimes feel that your knee will give out and not support your weight?” κ = .80 (.58, 1.0)
Localized pain: “Is your knee pain centered to one spot on the knee that you can point to with your finger?” κ = .84 (.63, 1.0)

Diagnostic Utility of Meniscal Symptom Index in Patients with Meniscal Tears

Patient Report and Study Quality ∗ Population Reference Standard Sens Spec +LR −LR
Clicking: “Do you feel a clicking sensation or hear a clicking noise when you move your knee?” 300 patients with knee pain Physician’s impression, supported by magnetic resonance imaging (MRI) findings .65 (.56, .73) .50 (.43, .58) 1.3 0.7
Catching: “Do you feel that sometimes something is caught in your knee that momentarily prevents movement?” .59 (.50, .67) .75 (.68, .80) 2.4 5.5
Giving way: “Do you sometimes feel that your knee will give out and not support your weight?” .69 (.60, .77) .53 (.45, .60) 1.5 5.9
Localized pain: “Is your knee pain centered to one spot on the knee that you can point to with your finger?” .74 (.65, .81) .49 (.31, .56) 1.5 5.3

∗ Among patients with none of these symptoms, 16% (95% CI: 2% to 30%) had symptomatic meniscal tear, while among those with all four symptoms, 76% (95% CI: 63% to 88%) had symptomatic meniscal tear.

Diagnostic Utility of Patient History: Meniscal and MCL Tears and Effusion

Figure 7-14, Medial collateral ligament rupture.

Patient Report and Study Quality Population Reference Standard Sens Spec +LR −LR
Self-noticed swelling 134 patients with traumatic knee complaints Knee joint effusion per MRI .80 (.68, .92) .45 (.35, .39) 1.5 (1.1, 1.9) .40 (.20, .90)
Trauma by external force to the leg MCL tear per MRI .21 (.07, .35) .89 (.83, .96) 2.0 (.80, 4.8) .90 (.70, 1.1)
Rotational trauma .62 (.41, .83) .63 (.51, .74) 1.7 (1.1, 2.6) .60 (.30, 1.1)
Age over 40 years Meniscal tear per MRI .70 (.57, .83) .64 (.54, .74) 2.0 (1.4, 2.8) .50 (.30, .70)
Continuation of activity impossible .64 (.49, .78) .55 (.45, .66) 1.4 (1.0, 2.0) .70 (.40, 1.0)
Weight bearing during trauma .85 (.75, .96) .35 (.24, .46) 1.3 (1.1, 1.6) .40 (.20, .90)

Physical Examination Tests

Screening

Figure 7-15, Identifying the need to order radiographs following acute knee trauma.

Reliability of the Ottawa Knee Rule for Radiography

Test and Study Quality Description and Positive Findings Population Interexaminer Reliability
Ottawa Knee Rule for Radiography in Adults Knee x-rays ordered when patients exhibited any of the following:

  • (1) Age 55 years or older

  • (2) Isolated patellar tenderness without other bone tenderness

  • (3) Tenderness of the fibular head

  • (4) Inability to flex knee to 90 degrees

  • (5) Inability to bear weight immediately after injury and in the emergency department

90 patients 18 to 79 years old visiting the emergency department of a general hospital with a knee injury that had occurred within the prior 7 days κ = .51 (.32, .71)

Diagnostic Utility of the Ottawa Knee Rule for Radiography

Figure 7-16, Nomogram. Assuming a fracture prevalence of 7% (statistically pooled from Bachmann and colleagues), an adult seen in the emergency department with an acute injury whose finding was negative on the Ottawa Knee Rule would have a 0.37% (95% CI: 0.15% to 1.48%) chance of having a knee fracture.

Test and Study Quality Description and Positive Findings Population Reference Standard Sens Spec +LR −LR
Ottawa Knee Rule for Radiography in Adults
2004 Metaanalysis 		As above Statistically pooled data from six high-quality studies involving 4249 adults X-rays .99 (.93, 1.0) .49 (.43, .51) 1.9 .05 (.02, .23)
Ottawa Knee Rule for Radiography in Children
2009 Metaanalysis 		Statistically pooled data from three high-quality studies involving 1130 children .99 (.94, 1.0) .46 (.43, .49) 1.9 (1.6, 2.4) .07 (.02, .29)

Reliability of the Pittsburgh Decision Rule for Radiography

Test and Study Quality Description and Positive Findings Population Interexaminer Reliability
Pittsburgh Rule for Radiography Knee x-rays ordered when patients exhibited any of the following:(1) Fall or blunt trauma mechanism
(2) Age older than 12 years or younger than 50 years or

  • (1) Fall or blunt trauma mechanism

  • (2) Age between 12 and 50 years

  • (3) Inability to walk four weight-bearing steps in emergency department

90 patients 18 to 79 years old visiting the emergency department of a general hospital with a knee injury that had occurred within the prior 7 days κ = .71 (.57, .86)

Diagnostic Utility of the Pittsburgh Decision Rule for Radiography

Test and Study Quality Description and Positive Findings Population Reference Standard Sens Spec +LR −LR
Pittsburgh Rule for Radiography As above As above X-rays .86 (.57, .96) .51 (.44, .59) 1.76 .28

Reliability of Clinical Assessments for Knee Osteoarthritis (OA)

Test and Study Quality Description and Positive Findings Population Interexaminer Reliability
Bony Enlargement With the patient’s knees extended, observation and palpation of the distal end of femur and the proximal end of tibia was made for the presence of enlargement, assessed as either present, absent, or unsure Interobserver Reliability = 25 subjects with symptomatic knee OA
Intraobserver Reliability = 88 subjects with symptomatic knee OA		 Interobserver κ = .66 (.32, 1.00)
Intraobserver κ = .98 (.93, 1.00)
Quadriceps Wasting With the patient’s knee extended, observation was made by comparing it with the opposite leg for any apparent reduced muscle bulk of the quadriceps over the anterior aspect of the thigh proximal to the base of the patella, assessed as either present, unsure, or absent Interobserver κ = .78 (.40, 1.00)
Intraobserver κ = .83 (.72, .95)
Knee Joint Crepitus Patient’s knee flexed and extended with the examiner’s hand over the anterior aspect of the knee joint and feeling for the presence of any palpatory/audible crepitus anywhere within the knee joint, assessed as present (palpable), present (audible), absent, or unsure Interobserver κ = .78 (.36, 1.00)
Intraobserver κ = .78 (.55, 1.00)
Medial Tibiofemoral Joint Tenderness With the knee flexed to about 90°, firm thumb pressure was used to palpate for any tenderness along the tibiofemoral joint line, differentiating tenderness on the medial and lateral side of the joint, assessed as present or absent medial tenderness and present or absent lateral tenderness Interobserver κ = .76 (.50, 1.00)
Intraobserver κ = 64 (.49, .80)
Lateral Tibiofemoral Joint Tenderness Interobserver κ = 1.00 (1.00, 1.00)
Intraobserver κ = .60 (.39, .80)
Patellofemoral Joint Tenderness With the knee extended, firm thumb pressure was used to palpate along the medial, lateral, superior, and inferior borders of the patella for any tenderness, assessed as present or absent Interobserver κ = .53 (.16, .89)
Intraobserver κ = .66 (.60, .92)
Anserine Tenderness With the knee flexed to about 90°, firm thumb pressure was used to palpate the area of the pes anserine bursa over the anteromedial superior aspect of tibia, about 3 to 4 fingers distal to the medial joint line, assessed as present or absent Interobserver κ = .49 (.09, .87)
Intraobserver κ = .73 (.61, .99)
Effusion: Bulge Sign With the knee extended, starting at the medial gutter, the examiner stroked upward 2 to 3 times toward the suprapatellar pouch and then stroked downward on the lateral aspect of the knee joint from the suprapatellar pouch toward the lateral joint line and observed for any wave of fluid reappearing on the medial side of the knee. Graded from 0 to 3 ( 0 = no wave produced on downstroke; 1 = larger bulge on medial side with downstroke; 2 = spontaneously returned to medial side after upstroke, 3 = so much fluid that it was not possible to move the effusion out of the medial aspect of the knee) Interobserver κ = .78 (.55, 1.00)
Intraobserver κ = .83 (.73, .94)
Effusion: Ballottement Test With the knee extended, using one hand to apply pressure over the suprapatellar pouch squeezing fluid downward while the thumb and index finger of the opposite hand applied anteroposterior pressure onto the patella, assessed as present without click, present with click (tap), or absent Interobserver κ = .73 (.45, 1.00)
Intraobserver κ = .77 (.60, .95)

Reliability of Detecting Inflammation

Figure 7-17, Fluctuation test.

Test and Study Quality Description and Positive Findings Population Interexaminer Reliability
Observation of swelling Not described 53 patients with knee pain κ = −.02 to .65
Palpation for warmth κ = −.18
Palpation for swelling κ = −.11 to .11
Fluctuation test With patient supine, examiner places thumb and finger around patella while pushing any fluid from suprapatellar pouch with other hand. Positive if finger and thumb are pushed apart 152 patients with unilateral knee dysfunction κ = .37
Patellar tap test With patient supine, examiner presses suprapatellar pouch and then taps on patella. Patella remains in contact with femur if no swelling is present κ = .21
Palpation for warmth Examiner palpates anterior aspect of knee. Results compared with uninvolved knee κ = .66
Visual inspection for redness Examiner visually inspects involved knee for redness and compares it with uninvolved side κ = .21

Reliability of the Stroke Test for Identifying Knee Joint Effusion

Test and Study Quality Description and Positive Findings Population Interexaminer Reliability
Stroke test Patient is supine and has knee in full extension. Starting at the medial tibiofemoral joint line, the examiner strokes upward two or three times toward the suprapatellar pouch in an attempt to move the swelling within the joint capsule to the suprapatellar pouch. The examiner then strokes downward on the distal lateral thigh, just superior to the suprapatellar pouch, toward the lateral joint line. Positive if fluid is observed on the medial side of the knee and quantified using a 5-point scale 75 patients referred to an outpatient physical therapy clinic for treatment of knee dysfunction for which effusion testing was deemed appropriate by the treating therapist κ = .64 (.54, .81)

Stroke Test Grading Scale
Grade Test Result
Zero No wave produced on downstroke
Trace Small wave on medial side with downstroke
1+ Larger bulge on medial side with downstroke
2+ Effusion spontaneously returns to medial side after upstroke (no downstroke necessary)
3+ So much fluid that it is not possible to move the effusion out of the medial aspect of the knee

Diagnostic Utility of Tests for Identifying Knee Joint Effusion

Test and Study Quality Description and Positive Findings Population Reference Standard Sens Spec +LR −LR
Ballottement test Examiner quickly pushes the patient’s patella posteriorly with two or three fingers. Positive if patella bounces off trochlea with a distinct impact 134 patients with traumatic knee complaints .83 (.71, .94) .49 (.39, .59) 1.6 (1.3, 2.1) .30 (.20, .70)
Self-noticed knee swelling + Ballottement test Combination of two findings .67 (.52, .81) .82 (.73, .90) 3.6 (2.2, 5.9) .40 (.30, .60)

Bulge sign 106 Examiner uses the flat of the hand to sweep upward from the lower medial side of the knee with sustained moderate pressure and then sweeps the hand downward on the lateral side of the knee. Positive if bulge appeared in the medial recess 312 participants (344 knees) with early knee OA Knee joint effusion per MRI .38 (.26, .52) .88 (.83, .93) 3.08 (1.8, 4.9) 0.71 (0.55, 0.86)
Patellar tap test Fluid in the suprapatellar pouch is pushed into the knee joint and held with sustained hand pressure. Positive if the patella is felt to abruptly stop as it contacted the underlying femoral condyles .10 (.02, .19) .96 (.93, .98) 2.25 (0.5, 6.3) 0.94 (0.84, 1.02)
Self-noticed knee swelling Patient reports knee swelling .49 (.35, .62) .86 (.81, .90) 3.35 (2.3, 5.1) 0.60 (0.44, 0.76)
Self-reported pain with leg straightening Patient reports pain with leg straightening .56 (.43, .70) .80 (.76, .85) 2.87 (2.0, 4.1) 0.54 (0.37, 0.71)
Self-noticed knee swelling
+
Self-reported pain with leg straightening 		Combination of two findings .36 (.23, .50) .93 (.90, .96) 5.19 (2.9, 9.7) 0.69 (0.54, 0.83)

Range-of-Motion Measurements

Reliability of Range-of-Motion Measurements

Figure 7-18, Measurement of active knee flexion range of motion.

Measurements and Study Quality Instrumentation Population Reliability
Active flexion sitting Standard goniometer 30 patients 3 days after total knee arthroplasty Interexaminer ICC = .86 (.64, .94)
Passive flexion sitting Interexaminer ICC = .88 (.69, .95)
Active flexion supine Interexaminer ICC = .89 (.78, .95)
Passive flexion supine Interexaminer ICC = .88 (.77, .94)
Active extension Interexaminer ICC = .64 (.38, .81)
Passive extension Interexaminer ICC = .62 (.28, .80)
Passive flexion
Passive extension 		Standard goniometer 25 patients with knee OA Interexaminer ICC = .87 (.73, .94)
Interexaminer ICC = .69 (.41, .85)
Passive flexion and extension Three standard goniometers (metal, large plastic, and small plastic) 24 patients referred for physical therapy Intraexaminer ICC
Flexion Extension
Metal .97 .96
Large .99 .91
Small .99 .97
Passive flexion
Passive extension 		Standard goniometer 43 patients referred for physical therapy where examination would normally include passive range-of-motion measurements of knee Intraexaminer ICC Interexaminer ICC
Flexion .99 Flexion .90
Extension .98 Extension .86
Passive flexion
Passive extension 		Visual estimation Interexaminer ICC = .83
Interexaminer ICC = .82
Passive flexion Standard goniometer 53 patients with knee pain Intraexaminer ICC = .82
Interexaminer ICC = .68
Passive flexion Standard goniometer 30 asymptomatic subjects Interexaminer ICC = .99
Active flexion
Active extension 		Standard goniometer 20 asymptomatic subjects Intraexaminer ICC = .95
Intraexaminer ICC = .85
Active flexion Universal goniometer 60 healthy university students Intraexaminer ICC = .86 to .97
Interexaminer ICC = .62 to 1.0
Passive flexion
Passive extension 		Standard goniometer 152 patients with unilateral knee dysfunction Interexaminer ICC
Involved knee Uninvolved knee
Flexion .97 Flexion .80
Extension .94 Extension .72
ICC, Intraclass correlation coefficient.

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