Knee Tests: The Complete Guide to Assessing the Meniscus, Ligaments, and Patella

The knee is probably the joint you'll have to examine most often in your career. Between running, soccer, basketball, and the classic "I felt something pop when I twisted," almost everyone who's active deals with knee discomfort at some point. The problem is that knee pain can come from many different sources: ligaments, menisci, patella, the IT band... and each has its own test.

In this guide we've gathered the 14 most relevant and most searched-for knee tests, organized by the structure they assess, so you know exactly which one to use depending on what you suspect.

Why do a structured knee assessment?

A well-performed knee exam gives you three things:

1. Diagnostic direction: it helps you distinguish between a ligament, meniscal, patellar, or soft-tissue (IT band) injury before referring out or programming.
2. An objective baseline: the ability to compare "before and after" a rehab process or a return to activity (RTP).
3. Confidence in load decisions: knowing whether an athlete can jump, change direction, or load in valgus/varus without aggravating an injury.

As always, these tests are clinical screening tools, not a substitute for an MRI or a medical diagnosis. But applied correctly, they give you very valuable information in just a few minutes.

The 14 knee tests, organized by structure

Anterior cruciate ligament (ACL)

Test	When to use it
Lachman Test	The most sensitive test for the ACL. Use it as your first option whenever ACL injury is suspected, especially in the acute phase with little pain/swelling.
Pivot Shift Test	When you want to assess the ACL's functional instability, not just laxity. More specific, but more uncomfortable for a patient with acute pain.
Lever Sign Test (Lelli)	An alternative when the Lachman is hard to perform (heavily muscled patient, pain, large knee) or as additional confirmation.

Meniscus

Test	When to use it
McMurray Test	The classic for suspected meniscal injury, especially if there's a painful "click" or pop when rotating the knee.
Apley's Compression Test	Complements the McMurray: combines compression and rotation to differentiate a meniscal issue from a ligament/capsular one.
Thessaly Test	Very useful in a sports context because it's done weight-bearing (standing), better simulating the movement that causes the injury.

Patella / anterior knee pain

Test	When to use it
Clarke's Sign (Patellar Grind Test)	When pain appears going up/down stairs or after sitting for a long time (patellofemoral pain).
Patellar Apprehension Test	If there's a history of patellar dislocation or subluxation, to assess patellar fear/instability.

Collateral ligaments and drawer tests

Test	When to use it
Anterior Drawer Test	As a complement to the Lachman to assess anterior tibial translation, especially in knees with swelling that makes the Lachman difficult.
Posterior Drawer Test	When a posterior cruciate ligament (PCL) injury is suspected, for example after a direct blow to the tibia.
Valgus/Varus Stress Test	To assess the collateral ligaments (medial/lateral), typical in injuries from a lateral blow or twisting while weight-bearing.

Other structures

Test	When to use it
Noble Compression Test	If the pain is on the lateral side of the knee and shows up mostly while running (iliotibial band syndrome).
Wilson Test (Osteochondritis Dissecans)	In adolescent athletes with anterior knee pain of unclear cause, to rule out osteochondritis dissecans.
Single-Leg Hop Test for ACL	In the final phase of rehab, to decide whether an athlete is ready to return to competition (return to play).

How to choose the right test for your context

Not every test fits every situation. Some practical guidelines to avoid getting lost:

• Twisting mechanism with an audible "pop"? Start by ruling out the ACL: Lachman as the first option, Pivot Shift or Lever Sign as support.
• Clicking, locking, or joint-line pain when rotating? Think meniscus: McMurray, Apley, and Thessaly complement each other well.
• Anterior pain "behind the kneecap," on stairs, or after sitting a long time? Check the patella with Clarke's sign and, if there's a history of dislocation, the patellar apprehension test.
• Direct blow or valgus/varus mechanism? Check the collateral ligaments with the valgus/varus stress test, and the drawer tests (anterior/posterior) if cruciate involvement is suspected.
• Lateral pain only while running, that goes away when you stop? The Noble test for the IT band is your first option.
• Adolescent with anterior knee pain of unclear cause? Don't rule out the Wilson test for osteochondritis dissecans.
• In the final phase of ACL rehab? The hop test gives you an objective measure for deciding on return to sport.
• First visit with no clear clues? Combine at least one test from each category (ACL, meniscus, patella, collaterals) so you don't miss anything important.

Also remember that these tests rarely work in isolation: a positive Lachman combined with a positive McMurray greatly increases the likelihood of a combined injury (ACL + meniscus), which is very common in real practice.

From assessment to patient follow-up

Running the test battery is great, but the real value lies in recording the results and being able to compare them over time. Did laxity improve after 6 weeks of rehab? Is the hop test already at 90% compared to the healthy leg? Has the pain on the Clarke test decreased in intensity?

With Movalytics you can log each of these knee tests per patient, record the result (positive/negative, degrees of laxity, hop test symmetry), and see progress in automatic charts, without relying on scattered spreadsheets or paper notes.

Frequently Asked Questions

Which test is most reliable for ruling out an ACL tear? The Lachman test is considered the most sensitive in most studies, especially when performed shortly after the injury, before pain and swelling limit movement. The Pivot Shift provides complementary information about functional instability. Can I use these tests if I'm not a physical therapist? As a trainer, these tests serve mainly as screening: if a result is positive or unclear, the right move is to refer the person to a healthcare professional for diagnostic confirmation (MRI, medical evaluation). They shouldn't be used to decide on treatment on your own. Why are several tests often combined for the same structure? Because no single test has 100% sensitivity and specificity. Combining, for example, McMurray + Apley + Thessaly for the meniscus, or Lachman + Pivot Shift + anterior drawer for the ACL, greatly increases the reliability of the clinical diagnosis (what's known as a test "cluster"). When is the hop test (single-leg jump) indicated? Mainly in the final phase of ACL rehab, as an objective criterion for deciding whether an athlete can safely return to training and competition (return to sport), by comparing the performance of the injured leg against the healthy one. Are these tests also useful for knee pain with no traumatic history? Yes, especially the patellar tests (Clarke, apprehension) and the Noble test for the IT band, which are very common in runners and people training with repetitive loads, even without a blow or sudden twist.