Facing the knee, place your thumbs in the soft tissue depressions on either side of the patellar tendon. Identify the groove of the tibiofemoral joint. Note that the inferior pole of the patella lies at the tibiofemoral joint line. As you press your thumbs downward, 

you can feel the edge of the tibial plateau. Follow it medially, then laterally, until you are stopped by the converging femur and tibia. By moving your thumbs upward toward the midline to the top of the patella, you can follow the articulating surface of the femur and identify the margins of the joint.

Note any irregular bony ridges along the joint margins.

■ Medial and lateral menisci. Palpate the medial meniscus. Press on the medial soft tissue depression along the upper edge of the tibial plateau with the tibia slightly internally rotated. Place the knee in slight flexion and palpate the lateral meniscus along the lateral joint line.

■ Medial and lateral joint compartments: MCL and LCL. Palpate the medial and lateral joint compartments of the tibiofemoral joint 

with the knee flexed on the examining table to approximately 90°. Pay special attention to any areas of pain or tenderness.

■ Medial compartment (Fig. 1). Medially, move your thumbs upward to palpate the medial femoral condyle. The adductor tubercle is posterior to the medial femoral condyle. Move your thumbs downward to palpate the medial tibial plateau.

Also medially, palpate along the joint line and identify the MCL, which connects the medial epicondyle of the femur to the medial condyle and superior medial surface of the tibia. Palpate along this broad, flat ligament from its origin to insertion.

■ Lateral compartment. Lateral to the patellar tendon, move your thumbs upward to palpate the lateral femoral condyle and downward to palpate the lateral tibial plateau. When the knee is flexed, the femoral epicondyles are lateral to the femoral condyles.

■ Also on the lateral surface, ask the patient to cross one leg so that the ankle rests on the opposite knee and find the LCL, a firm cord that runs from the lateral femoral epicondyle to the head of the fibula.

■ Patellofemoral compartment: patellar tendon. Palpate the patellofemoral compartment. Locate the patella and trace the patellar tendon distally until you palpate the tibial tuberosity. Ask the patient to extend the knee to make sure the patellar tendon is intact.

With the patient supine and the knee extended, compress the patella against the underlying femur, and gently move it medially and laterally, assessing for crepitus and pain. Ask the patient to tighten the quadriceps as the patella moves distally in the trochlear groove. Check for a smooth sliding motion (the patellofemoral grinding test).

FIGURE 1. Medial compartment of the knee.

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