These include "Tietzes’, ‘Slocum’, ‘Losee’, pivot jerk and pivot shift. The authors find the lateral pivot shift or pivot jerk to be the easiest, most consistent and least distressing to the patient, specifically testing anterior cruciate ligament integrity. It is important to realise that the pivot shift is difficult, requiring much practice before it can be considered reliable.

As already stated, the anterior cruciate ligament causes the tibia to rotate externally, coming from 30 degrees flexion to extension. If the ligament is deficient this does not occur, causing the subluxed tibia to rotate internally as the tibial condyle subluxes forwards on the femoral condyle. When the knee is flexed at about 30 degrees, the lateral tibial condyle reduces onto the lateral femoral condyle. The joint then remains reduced through further flexion.

The lateral pivot jerk is aimed at producing a forced subluxation/reduction of the tibial condyle, in order to elicit a detectable sudden change with acceleration of flexion/extension. If performed correctly, the test is not painful and may often be clinically very satisfying as the patient states: ‘that is what my knee does when it gives way’, thus showing confidence in the examiner’s ability to detect the cause of the problem.

The test combined internal rotation of the tibia extended from the ankle, and valgus force, pressing the proximal tibia with the other hand for maximum reduction of the subluxation. In this position the knee is flexed with a click of reduction of the tibial condyle onto the femoral condyle, rendering the lateral pivot shift positive . Maintaining this position the knee is slowly extended; at approximately 30 degrees flexion a click into subluxation occurs, rendering the jerk test positive. A combination of these tests is known as the ‘lateral pivot jerk’ test.

Interpretation of this test in the locked knee should be very reserved, as a positive lateral pivot jerk is often masked by locking. It is also important to bear in mind that patients with ligament laxity may elicit a physiological lateral pivot jerk: the ‘screwing home’ still occurs later in extension, but is less marked, giving the appearance of a lateral pivot jerk. In these cases, the other knee will have the same sign and there will be no ‘giving way’ history of the ‘something/nothing’ type.

These tests should be performed later on at examination, aiming at confirming or excluding an already suspected diagnosis derived from the previously discussed techniques.

This is a test for posterolateral rotatory instability (see above). Posterolateral instability may be detected with increased external rotation on the tibia at 90 degrees flexion.

This is a test for meniscal tears. It is important that its interpretation is taken in the context of the whole examination, as false positives and negatives are common with this technique. It aims to reproduce in part the mechanism of injury to the meniscus with a palpable click, or at least to elicit pain.

As described by McMurray, the knee should be flexed completely so that the heel rests on the buttock, or as near to this point as possible. The ankle is then grasped in the right hand (examining the right knee) and the joint is controlled by the left hand, with the thumb and forefinger firmly grasping on either side at the level of the posterior aspect of the joint and behind the external and internal lateral ligaments respectively. The ankle is twisted by the right hand, so that the knee is rotated inwards and outwards to its full extent: if a lesion of the external or internal cartilage is present, a definite click will be felt under the finger or thumb of the left hand.

Many modifications of this test exist. Adding an adduction or abduction force often assists in eliciting a positive result, as does gradually extending the knee in each direction.

Kept in context, this may be a helpful diagnostic test. With the patient lying prone, the knee is flexed to 90 degrees. The knee is then rotated whilst a compression force is applied. If the symptoms are reproduced, this may indicate a meniscal tear. Rotation is repeated while the leg is pulled upwards with the thigh held down. The distraction test may produce pain if ligament damage is present.

Hamstring tightness is assessed by measuring the ‘theta’ angle: as the patient lies supine, the examiner’s hand is placed under the lumbar spine to ensure lumbar lordosis. The hips is then flexed to 90 degrees and the knee is extended.

The angle the tibia makes with the perpendicular line is called the ‘theta’ angle . If this is greater than 15 degrees, the hamstrings may be considered tight, predisposing to tears and patellofemoral pain.

Quadriceps tightness can be quantified with the patient lying prone: both knees are flexed by the examiner until they reach a s endpoint. The distance between the ankle and the buttock is then measured, the ideal being where the posterior ankle is about to touch the buttock.

Both these tests are obviously quite subjective but, when performed consistently by the same examiner, they give a good idea of how muscle tightness may be contributing to overuse injuries in particular.