Finochietto Sign (Jump Sign): Knee Exam for Posterior Meniscal Tears

The Finochietto sign, also called the jump sign, is a physical examination maneuver for the knee. It is performed during an anterior drawer–type manipulation and is used to look for a displaceable posterior meniscal tear. Losee described it as a pathognomonic sign of a posterior longitudinal tear of the knee meniscus [1]. This guide explains what the sign is, how it is performed, how to interpret it, and where it fits among modern knee tests.

What Is the Finochietto Sign Used For?

The Finochietto sign is used to detect meniscal pathology at the back of the knee, particularly a tear of the posterior horn of the medial meniscus. A longitudinal or bucket-handle tear is the pattern most often linked to it [1].

Your original text said the sign tests the ACL and the meniscus simultaneously. Be careful with that wording. The maneuver resembles the anterior drawer test, which is the classic test for ACL insufficiency [2,3], and that resemblance is why the two are often confused. The jump sign itself was described as a meniscal sign, and laxity from a cruciate injury should not be read as a positive result. A knee with a torn meniscus may also have an ACL injury, so the sign can be positive alongside ACL laxity, but it does not test the ligament.

How to Perform the Finochietto Sign

1. Position the patient supine and relaxed, with the hamstrings not contracting.
2. Flex the knee and stabilize the foot. Use the same set-up as for the anterior drawer test.
3. Pull the tibia forward with firmer anterior traction than in a routine drawer test.
4. Feel and listen for a snap or a skip as the tibia translates forward.
5. Reduce the tibia by pushing it posteriorly, and note whether the femoral condyle glides back over the posterior horn of the medial meniscus.

Always compare with the opposite knee. Perform the maneuver gently in an acutely painful, swollen knee.

What Is a Positive Result?

A positive Finochietto sign produces an audible snap and/or a palpable skip during forward traction. When the tibia is then pressed backward, the femoral condyle glides back over the posterior horn of the medial meniscus, and the jump disappears.

When Is Reduction of the Meniscus Needed?

Sometimes the displaced meniscus must be reduced after a positive test. This raises suspicion of a full posterior separation of the medial meniscus and/or a longitudinal or bucket-handle tear. In that setting, further assessment with MRI and orthopedic evaluation is reasonable [1].

Limitations and Diagnostic Accuracy

No single meniscal examination maneuver is reliable on its own. In primary care, history-taking added some diagnostic value, but physical examination added little for detecting meniscal tears [4]. A systematic review of knee examination found that a composite of tests and history performed much better than any single maneuver [5]. Other meniscal tests, such as the Thessaly test, have reported good accuracy in selected cohorts [6]. Treat the Finochietto sign as one piece of a full knee examination, never as a stand-alone diagnosis.

Clinical Takeaways

• The jump sign points to a posterior meniscal tear, not to ACL laxity.
• A snap or skip on forward traction that disappears with posterior pressure on the tibia is the typical finding.
• A sign that needs manual reduction should prompt suspicion of a bucket-handle or full posterior tear.
• Confirm with a cluster of tests and imaging rather than relying on one maneuver.

Research Limitations

The original description of the sign is a brief report from 1983 [1]. High-quality diagnostic accuracy studies for this specific maneuver are limited, so treat the findings as supportive and confirm with MRI and arthroscopy when clinically indicated.

Frequently Asked Questions (FAQ)

What is the Finochietto sign?
It is a knee examination maneuver, also called the jump sign, used to detect a displaceable posterior meniscal tear, typically of the medial meniscus [1].

Does the Finochietto sign test the ACL?
Not directly. It resembles the anterior drawer test, which assesses ACL insufficiency [2,3], but the jump sign was described as a meniscal sign. Cruciate laxity alone is not a positive result.

What does a positive Finochietto sign feel like?
The examiner hears a snap and/or feels a skip during forward traction of the tibia. The jump disappears when the tibia is pressed backward [1].

Which tears does it suggest?
A posterior longitudinal tear, a full posterior separation of the medial meniscus, or a bucket-handle tear, especially if the meniscus needs reduction afterward [1].

Is the Finochietto sign enough to diagnose a meniscal tear?
No. Meniscal examination is more reliable as a cluster of tests combined with history [4,5]. MRI or arthroscopy is used to confirm the diagnosis.

What other tests assess the meniscus?
Joint line tenderness, McMurray, Apley and the Thessaly test are commonly used [5,6].

When should I see an orthopedic specialist?
See one for a locked knee, persistent clicking or catching, recurrent giving way, or swelling after a twisting injury.

References

1. Losee RE. Finochietto’s “Jump Sign”: pathognomonic sign of a posterior longitudinal tear of the meniscus of the knee. Iowa Orthop J. 1983;3:55–56. PMCID: PMC2328732.
2. Losee RE, Johnson TR, Southwick WO. Anterior subluxation of the lateral tibial plateau: a diagnostic test and operative repair. J Bone Joint Surg Am. 1978;60(8):1015–1030.
3. Galway HR, MacIntosh DL. The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res. 1980;(147):45–50.
4. Diagnostic value of history-taking and physical examination for assessing meniscal tears of the knee in general practice. Clin J Sport Med. 2008;18(1):24–30.
5. Solomon DH, et al. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA. 2001;286(13):1610–1620.
6. The Thessaly test for detection of meniscal tears: validation of a new physical examination technique for primary care medicine. Clin J Sport Med. 2009;19(1):9–12. PMID: 19124977.