Exam (elaborations)
SCS Review (2).
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Exam of 29 pages for the course SCS at SCS (SCS Review (2).)
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SCS Reviewcontents of the posterolateral corner of the knee - ANS-LCL, popliteus tendon, popliteofibular
ligament
MOI for a PLC injury - ANS-A common mechanism of injury to the PLC is a direct blow to the
anteromedial knee. However, hyperextension and non-contact varus stress injuries can also
damage the PLC
special tests for PLC injury - ANS-Varus stress test, dial test, ER recurvatum test of Hughston
Dial test results - ANS-(+) at 30 deg and (-) at 90 deg: injury to the PLC only
(+) at both 30 deg and 90 deg: injury to the PLC and PCL
PCL restriction in early phase - ANS-PWB, HS exercises are not allowed for the first 6-8 weeks
due to the risk of stressing the ligament; caution with flexion range of motion early on as well as
hyperextension activities
PCL moi - ANS-hyperflexion or hyper extension. Hyperflexion involves a direct flow to the knee
such as a fall or the dashboard in an MVA
risk factors of patella dislocation - ANS-females, shallow femoral groove, flat sulcus, patella alta,
general laxity, pronated feet, quad weakness
neurovascular concern with TF dislocation - ANS-politeal artery and common peroneal/tibial
nerves
OCD grading scale - ANS-1: softening and swelling of the cartilage
2: fissuring and fragmentation of an area less than one half inch in diameter
3: fissuring and fragmentation in an area greater than one half inch in diameter
4: cartilage is eroded down to the subchondral bone
intrinsic and extrinsic risk factors for PFPS; CPG risk factors - ANS-intrinsic: anatomical
anteversion of the hip, trochlear or patellar dysplasia
extrinsic: training errors, footwear, movement patterns
malalignment and maltracking of the patella are also modifiable risk factors that can come from
different sources like muscle flexibility issues and excessive lateral pressure
CPG: decreased LE flexibility, reduction of vertical jump height, and hypermobile medial patella
glide
,anterior medial instability comes from - ANS-MCL, medial capsule, ACL, and/or posterior
oblique ligament
anterior lateral instability comes from - ANS-ACL, Lateral capsule, arcuate complex
testing for rotary instability - ANS-perform an anterior drawer but with the foot in either ER/IR
minimally (not max)
perform in 15 deg of ER for AMRI (Slocum test)
Plica palpation and risk factors for irritation - ANS-the medial plica is most often involved, you
can palpate it against the superior portion of the patella when the knee is flexed to 30 deg to
elicit pain
RF: running on side hills, biking in toe clips, poor LE control, horseback riders
MPFL precautions - ANS-range of motion is limited to 0-30 deg in first week and progresses by
30 deg until full ROM is allowed at week 6; work from 90-30 deg strengthening early on to allow
the patella to stay in the groove and not stress the repair
hoffa syndrome - ANS-fat pad syndrome; common in hyperextension and hypermobile
individuals; common in post arthroscopy patients as the portals go through it and can become
fibrotic; highly innervated structure
articular cartilage change with OA - ANS-increased collagenase and nitric oxide has caused
change in composition that decreases shock absorption quality
muscle attachments to the menisci - ANS-medial: semimembranosus
lateral: popliteus
good prognostic factors for mensicus - ANS-age under 35, peripheral damage, longitudinal,
short tear, acute injury, stable knee
poor prognostic factors for meniscus - ANS-older patient, central damage, complete or bucket
handle tear, chronic injury, unstable knee
special test prometrics for meniscal testing - ANS-Thessaly's is the most specific and also highly
sensitive
McMurray's is better for ruling in (specific)
Dynamic test and KKU compression test also have good sensitivity, specificity and (+) LR
CPR of meniscus - ANS-joint line tenderness, history of catching or locking, pain with
flexion/extension overpressure and (+) McMurray's
Very specific cluster, not sensitive
, articular cartilage grades of damage - ANS-1: superficial lesion,
2: lesion extends <50% of cartilage depth
3: defect is >50% as well as into the calcified layer but not into the subchondral bone
4: severely abnormal and into the subchondral bone
articular cartilage anatomy - ANS-made of type 2 collagen fibers (hyaline cartilage); split into
four zones of tangential, transitional, radial, and calcified
it is anisotropic; and it is stiffest when loaded rapidly and its made to move rapidly. relies on
synovial fluid for nourishment and is avascular below the tidemark level
mechanical loading promotes interstitial fluid in and out of the permeable collagen-proteoglycan
matrix that facilitates the movement of nutrients from the synovial fluid into the collagen matrix
and stimulates an anabolic chondrocyte response
surgical options for articular cartilage - ANS-Microfracture: better outcomes with low demand
patients
autologous chrondrocyte implantation (ACI): 2 part surgery where you harvest chrondrocytes
and re-implant; used for medium to larger lesions with low or high demand
Osteochondral autograft transplantation system
(OATS): remove plug from non weightbearing surface to plug into the lesion; used for large
lesions and high demand
CPG shows that athletes with OAT procedure have better outcomes than ACI or microfracture
categories of PFPS - ANS-overuse/overload, muscle performance deficits, movement control
deficits, mobility impairments of knee or foot
pro metrics of ACL testing - ANS-Lachman: sensitive and specific, gold standard
anterior drawer: not great
pivot shift: sensitive but not specific
prometrics of PCL testing - ANS-posterior drawer test is the most sensitive, posterior sag test is
the most specific
Anterolateral Rotary Instability (ALRI) moi and special tests - ANS-MOI: acute IR and varus
stress on the weightbearing knee
Jerk, Losee, flexion rotation drawer test and sidelying slocum test
CPG risk factors for medial meniscus tear; for acute meniscus tear - ANS-female, older age,
higher BMI, lower physical activity
cutting and pivoting sports
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