The stature of the patient is noted on entrance for examination. The patient is viewed standing normally from front, back and also from the side. It is particularly important to notice:

Skeletal deformities;

Shortening;

Deformities indicating an old fracture;

Femoral torsion;

Tibial torsion;

Genu varum or valgus

This patient demonstrates genu varum of the left leg

Recurvatum or flexion deformities in the knees

Pes planus or cavus

Scars pointing to previous surgery;

Any degenerative deformity, for example valgus apparent on weight bearing;muscular deficiencies, for example wasted quadriceps;

Cyst or swelling, for example ‘baker’s cyst’.

The patient is asked to squat if no contra-indication to this position exists, like gross effusion or acute ligament tear. This gives a rough idea of the quadriceps power and patellofemoral integrity. If medial pain is felt at full squat, tear of the posterior horn of the medial meniscus should be suspected (positive squat test).

The patient sits on the side of the examination couch and allows the knees to hang.

The examiner notes any abnormal patellar position, deformity, cysts or swelling, and assesses the tone and bulk of the quadriceps, particularly of the vastus medialis obliquus: this is one of the medial quadriceps with its attachment running one-third of the way down the medial patella. It plays a major role in the extension of the knee as well as in patellar tracking and stability. The tone and bulk of the quadriceps can also be assessed in the extended knee by comparison with the other knee .