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Valgus Stress Test
The Valgus Stress test is used to detect the presence of insufficiency of the medial compartment of the knee, particularly the medial collateral ligament. This test is also called the valgus test and the abduction stress test.
The Valgus Stress test is conducted with the knee in two positions:
The test is first performed with the knee in full extension. With the patient in the supine position, hold the involved limb against your body with one hand supporting the calf while the other hand holding the lower outer thigh. Apply a valgus stress using the thigh contact as a fulcrum and using the body to lever the lower leg outwards. Observe for the extent of abduction and gapping on the medial side of the knee.
The test is then repeated with 30 degrees of knee flexion.
The Valgus Stress test is positive if abduction and gapping is greater than the uninvolved side, with or without pain. Also, observe for an indentation of the skin over the medial joint line called the ‘suction sign’.
If the test is positive with the knee flexed to 30 degrees but negative with the knee fully extended, the medial collateral ligament is damaged.
If the test is positive with the knee at both 30 degrees of flexion and at full extension, a number of structures are implicated including:
• Medial collateral ligament
• Posterior cruciate ligament
• Posteromedial capsule
The severity of the injury is graded by the extent of gapping and the presence of the “suction sign”.
- Grade 1 is when the gapping is less than 5 mm and only a minor suction sign is present.
- Grade 2 is gapping between 5 and 10mm together with a significant suction sign.
- Grade 3 is gapping greater than 10 mm, the loss of firm end-feel, and a marked suction sign.
It’s important to note that if the injury is accompanied by haemarthrosis, the suction sign will be absent.
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