RxPG - OSCE Knee Examination: Performance Criteria

Performance criteria in an OSCE are the criteria against which your performance in the station is benchmarked by the examiners. The following is the performance criterion list for an OSCE for Knee examination. For every performance criterion there are three grades a, b, and c. The grade "a" carries the maximum marks and "c" the least. Look at the performance criteria in the OSCE for knee examination below. These following performance criteria for knee exam will cover OSCE stations like knee pain, lower limb examination and knee examination.

Performance Criteria (Physical Exam):

1. Checked knee flexion:
a) With patient prone the ankle is flexed towards the buttocks.
b) With patient supine the ankle is flexed towards the buttocks.
c) Knee flexion range was not assessed.

2. Checked knee extension:
a) With patient supine or sitting, the knee is extended.
b) With patient prone the knee is extended.
c) Knee extension range is not assessed.

3. Checked strength of quadriceps:
a) Knee is slightly bent and leg is straightened against resistance.
b) Knee is fully extended and examiner attempts to flex knee against patient resistance.
c) Quadriceps strength was not assessed.

4. Checked strength of knee flexors:
a) Patient is prone or sitting and attempts to flex knee against examiners resistance.
b) Patient is supine and attempts to flex knee against examiners resistance.
c) Knee flexion strength was not assessed.

5. Checked strength of tibialis anterior:
a) Patient is seated or supine and attempts to resist flexion of ankle towards the head or
upwards against the examiner or is able to walk on heels easily.
b) Patient is seated or supine and attempts to resist flexion of ankle towards the head or
upwards with foot everted/inverted.
c) Tibialis anterior strength was not assessed.

6. Checked strength of hip flexors:
a) Patient is seated and attempts to flex hip upwards against resistance.
b) Patient is supine and attempts to flex hip upwards against resistance.
c) Hip flexor strength was not assessed.

7. Evaluated patellar tracking:
a) With patient seated, he/she is instructed to repetitively flex and extend the knee
actively while examiner monitors patellar motion.
b) With patient supine, he/she is instructed to repetitively flex and extend the knee
actively while examiner monitors patellar motion.
c) Patellar tracking was not assessed.

8. Evaluated anterior cruciate ligament:
a) 1.Patient is supine; examiner flexes patient’s knee 20o while pushing down on thigh,
lower leg is pulled anteriorly.
2.Patient is supine; examiner flexes knee between 75-90o and while sitting on foot,
pulls lower leg forward.
b) 1.Patient is supine; knee is flexed less than 20o or more than 40o while pushing down
on thigh, lower leg is pulled anteriorly.
2.Patient is supine/seated while examiner flexes knee less than 75o and while
sitting on foot, pulls lower leg forward.
c) Anterior cruciate ligament was not assessed.

9. Evaluated posterior cruciate ligament:
a)1.Patient is supine; the knee and hip are flexed to 90o while examiner monitors for and
“drop back” of tibial tubercle.
2.Patient is supine; the legs are fully extension while examiner picks up heels and
monitors for dimpling below the kneecap.
3.Patient is supine; knee is flexed to 90o while examiner sits on foot and lower leg is
pushed backwards.
b)1.Patient is supine; the knee and hip are flexed less than 90o.
2.Patient is supine; knees are not fully extended while the examiner picks up heels and .
monitors for dimpling below knee cap.
3.Patient is supine; knee is flexed to less than 90o or the knee is pulled anteriorly then
pushed posteriorly.
c) Posterior cruciate ligament was not assessed.

10. Evaluated lateral collateral ligament:
a) Knee is flexed 20o to 30o while varus stress is applies to knee.
b) Knee is fully extended or flexed greater than 30o while varus stress applied to knee.
c) Lateral collateral ligament was not assessed.

11. Evaluated medial collateral ligament:
a) Knee is flexed 20o to 30o while valgus stress is applied to knee.
b) Knee is fully extended or flexed greater than 30o while valgus stress is applied to
knee.
c) Medial collateral ligament was not assessed.

12. Palpated patella:
a) Patella is palpated at medial, lateral, superior and inferior borders.
b) Patella is not palpated on all borders.
c) Patella is not palpated.

13. Palpated joint line:
a) Both medial/lateral joint lines are palpated anteriorly and posteriorly.
b) Joint line is not palpated throughout.
c) Joint line was not palpated.

14. Palpated the iliotibial band
a) Palpated the laterally situated iliotibial band
b)
c) Iliotibial band not palpated

15. Evaluated flexibility of hamstrings.
a) Patient lies on back, hip is extended to 90 degrees and the ankle is subsequently
extended.
b) Patient lies on back and the leg is extended without initially flexing the hip to 90
degrees or assessed unilaterally.
c) Hamstrings were not assessed.

16. Evaluated flexibility of rectus femoris:
a) Patient lies on stomach, while examiner flexes heel toward buttocks.
b) Patient lies on stomach, however, examiner fails to fully flex heel towards buttocks or
assessed unilaterally.
c) Rectus femoris was not assessed.

17. Evaluated flexibility of the iliotibial band.
a) In sidelying position, the knee is flexed to 90 degrees and extended backwards to end
range extension. Gripping the ankle, an attempt is made to lower the knee towards the
table or to monitor descent of the knee bilaterally.
b) Done only unilaterally.
c) Iliotibial band flexibility was not assessed.

18. Checked for effusion:
a) Tissue about the kneecap (while knee is extended) is compressed about the kneecap
while the examiner pushes down on the patella.
b) Tissue about the kneecap (with knee flexed) is compressed about the kneecap while
the examiner pushes down on the patella.
c) Joint effusion was not assessed.

19. Evaluated both knees:
a) Examiner evaluated both knees.
b) B.
c) Examiner did not evaluate both knees.

20. Evaluated gait:
a) Examiner evaluated gait.
b)
c) Examiner did not evaluate gait.

Well article will give you insights about the evaluation process of an Objective Structure Clinical Examination. Most of the plabbers are usually unaware of this process.