This is useful where an iliotibial band friction syndrome is suspected. A positive Ober’s test offers a good prognosis for stretching the iliotibial band in order to relieve the characteristic lateral pain that accompanies this syndrome.

The patient lies on the side with the thigh of the unaffected leg next to the table and flexed enough so as to obliterate any lumbar lordosis. The examiner grasps the affected leg tightly with one hand, while the pelvis is stabilised with the other. The hip is extended so that the thigh is in line with the body to catch the iliotibial band on the greater trochanter, and then adducted.

If shortening of the iliotibial band is present, the hip will remain passively abducted in direct proportion to the amount of shortening. With adduction pressure applied to the leg, that is, tightening of the iliotibial band and then flexing and extending the knee, the characteristic pain at the lateral femoral condyle may be reproduced ‘modified’ Ober’s test’. This can be of great diagnostic benefit, particularly as the patient gains confidence knowing that the symptoms have been identified.

This test is appropriate where patellofemoral pain is suspected. The pain must initially be reproduced by an isometric contraction of the quadriceps with the patient flexing the knees, squatting, or going up and down steps. Once the pain has been reproduced, it may be eased by a medial glide of the patella; this medial glide may also be performed as the patient squats or walks up and down steps, with a similar relief of symptoms. Pain relief by a medial glide of the patella is diagnostic of patellofemoral pain.

At the end of examination it may be necessary to seek the assistance of additional tests:

This is performed as a sterile technique. The most common method is to introduce a wide bore needle, for example 18-gauge, into the lateral suprapatellar pouch and to slowly drain out the fluid. Examination of this fluid may assist the diagnostic process, either because of its gross appearance (blood in the anterior cruciate ligament rupture), or its pathology. The fluid is placed into a heparinised and clotted tube for testing of cells, protein, crystals and culture. Fat globules in the aspirate indicate a chondral or osteochodral fracture.

Radiological examination is often necessary. The standard and lateral views will show any abnormalities present.

Additional views requested should be intercondylar, weight bearing indicating articular cartilage thickness, and skyline.

A supine plain radiograph may show a fluid level indicating fat globules and therefore a fracture.

Radiographs may contribute a great deal to the diagnosis of knee conditions. Yet, far too many patients present after having been told that their radiographs are normal, therefore their knees are normal. The structures most commonly damaged are the menisci and ligaments, and these are not radio-opaque.