Clinimetric properties of the knee extension prone test (KEPT): a new method to assess knee hyperextension deficit

Review written by Dr Travis Pollen info

Key Points

  1. Existing methods for identifying deficits in knee hyperextension (goniometry, tibial inclinometry, and computerized photogrammetry) are time and skill-intensive.
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Deficits in knee hyperextension are common in patients who have knee pain (e.g. patellofemoral pain/tendinopathy) or are postoperative (e.g. ACL reconstruction). These deficits can affect gait, energy expenditure, long-term knee health, and quality of life.

There are several existing methods of measuring knee hyperextension deficits including goniometry, tibial inclinometry, and computerized photogrammetry. These methods tend to be time and skill-intensive, requiring identification of multiple anatomical landmarks, bilateral measurements, and a side-to-side calculation to quantify deficits.

The purpose of this study was to determine the intra-rater reliability, inter-rater reliability, and concurrent validity of a new method of assessing knee hyperextension deficit: the knee extension prone test (KEPT).

Deficits in knee hyperextension are common in patients who have knee pain or are postoperative.
In practice, it may be optimal to use the knee extension prone test as a complement to one of the bilateral measurement techniques.


For inter-rater reliability, two raters assessed 100 participants’ knee extension using five techniques (see Table 1 for demographics).

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