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NBPME Pearls > Arthroscopy > Flashcards

Arthroscopy Flashcards

1
Q

Why do portals need to be separated as widely as possible?

A

to avoid skin necrosis if portals are placed too close to each other

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2
Q

if an instrument falls or breaks within a joint, what should be done immediately?

A

outflow of saline should be shut down while the inflow is left open to keep the joint distended for retrieval of broken piece

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3
Q

what anatomical structures are considered when making an anterolateral portal?

A

btwn EDL and superficial peroneal n.

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4
Q

when is the transmalleolar approach for lesions of the talus contraindicated?

A

in children with open epiphysis

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5
Q

What anatomical structures are considered when making an anteromedial portal?

A

btwn TA tendon and saphenous vein

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6
Q

what is the most common size and angulation of an arthroscope used in an ankle?

A

2.7mm and 30 deg

or 0 deg of angulation

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7
Q

what is the min. distance an accessory portal should be placed btwn two working portals?

A

at least 1cm apart to avoid skin necrosis

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8
Q

in anterior soft tissue impingement of the ankle, pathology is generally limited to what areas?

A

syndesmosis and lateral gutter

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9
Q

when using a posterolateral approach, what structures should you watch out for?

A

sural nerve
saphenous vein
also avoid entering the STJ

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10
Q

transmalleolar portals are more often required on which side of the ankle joint and why?

A

on the medial side because lateral dome lesions are more anterior than on the medial side, and becuase the lateral malleolus is further posterior than the medial malleolus

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11
Q

what are 3 basic joint surveying techniques in ankle arthroscopy?

A

scanning
pistoning
rotating

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12
Q

prior to beginning arthroscopy, which portal is developed first?

A

the medial portal is developed first and the scope is placed in to survey teh joint prior to lateral portal development

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13
Q

what are the contraindications for manual distraction and/or gravity distraction?

A

tight ankles
pathology not easily accessible
prolonged procedures

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14
Q

what are the contraindications to the use of skeletal distraction?

A

local or generalized osteopenia
open epiphysis
lax ligaments

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15
Q

what are some indications for the use of single heavy pin distraction (3/16 inch)?

A

large bone structure in males
long cases or difficult pathology
very tight ankles
ankle arthrodesis

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16
Q

what are some advtgs of double pin (7/64) distraction?

A

better control
less stress riser than 3/16 inch
less chance of pin tract infection

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17
Q

when a 3/ 16.5 invasive distraction is used, how long post-operatively should the patient avoid athletic activity or heavy work?

A

8-10 wks to decrease the risk of fx

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18
Q

when 7/64.5 invasive distraction is used, when can the patient return to activity?

A

4-6 wks

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19
Q

what specific type of synovitis occurs in 3 stages?

A

chronic synovial chondromatosis

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20
Q

which disease entity is characterized by synovitis with advanced papillary formation and hemosiderin cells present?

A

pigmented nodular synovitis

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21
Q

what is used in drilling an OCD of the talar dome?

A

0.062 K wire

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22
Q

what is the MOI for a medial talar dome lesion?

A

plantarflexion and inversion

23
Q

what is the MOI for a lateral talar dome lesion?

A

inversion of the foot with the ankle dorsiflexed and tibia internally rotated on the talus

24
Q

how should a bone graft be placed in articular cartilage of teh talar dome?

A

1-2mm below the level of teh cartilage

25
Q

what is one method that has been proven helpful in viewing chondral lesions of the ankle joint?

A

methylene blue dye injected into the joint and then washed out with irrigant saline

26
Q

what technique is used in arthroscopic ankle arthrodesis?

A

arthroscopic transmalleolar cross-screw fusion

27
Q

what are some advantages of arthroscopic approach to ankle fusion over the open method?

A

less surgical morbidity and improved cosmesis

28
Q

wha tis a disadvantage of the arthroscopic approach to ankle fusion?

A

severe varus/valgus alignment is difficult to correct arthroscopically

29
Q

what is a contraindication to doing arthroscopic ankle fusion?

A

varus/valgus malalignment > 15 deg

30
Q

Name the arthroscopic technique that involves insertion of another object such as a probe beside a target structure into the field of view of the arthroscope in order for the physician to better conceptualize the relative positions of these objects relative to adjacent structures.

A

triangulation

31
Q

according to R.W. Jackson (1982) is more relief of symptoms achieved with diagnostic arthroscopy attributable to joint lavage or lyses of adhesions?

A

joint lavage- 21%

lysis of adhesions- 4%

32
Q

what is the classification system for talar dome lesions?

A 
Berndt and hardy 
sTage 1- compression of articular cartilage
Stage 2-  an incompelte fx
stage 3- non displaced complete fx
stage 4- displaced complete fx
33
Q

which side of the talar dome usually produces a shallow wafer-shaped fx?

A

anterior lateral

34
Q

which side of the talar dome procedues deep, cup-shaped lesion?

A

posterior medial

35
Q

what is the procedure for sterilization of a scope?

A

1st case- ethylene oxide gas
if additional cases- activated glutaraldehyde solution for 20 min
*arthroscopes cannot be autoclaved

36
Q

what is the probable diagnosis if only 10-12 mL of saline can be injected into the ankle joint capsule of a normal sized adult?

A

capsular adhesions or fibrosis

37
Q

plantarflexion of teh foot increases the visualization for which group of arhtroscopic portal approaches?

A

medial

38
Q

dorsiflexion of the foot increases the visualization for which group of arhtroscopic portal approaches?

A

lateral

39
Q

Name indications for ankle arthroscopy.

A 
chronic ankle instability 
persistent ankle joint pain
OCD
anterior impingement exostosis
ankle fx
ankle fusions
arthritis
adhesive capsulitis
synovitis
meniscoid bodies
chondromalacia,
40
Q

describe pistoning.

A

movement of arthroscope towards or away from an object

*pistoning would increase object’s apparent size while decreasing total field of vision

41
Q

describe scanning.

A

sweeping side to side or up/down to get a more complete view of the joint. the idea is to go from known to unknown areas of the joint to distinguish normal from pathological structures

42
Q

describe rotation.

A

movement of arthroscope about its axis. the field of vision is changed depending on teh obliquity of the arthroscope tip. the larger the degree of tip cut, the wider the field.

43
Q

what instrument has a sharp point and is used to pierce soft tissue and capsule?

A

trocar

44
Q

what isntrument has a blunt end and is used to enter a joint?

A

obturator- used to prevent iatrogenic cartilaginous damage

45
Q

what is used to distend the ankle joint and maintain a clear view of teh camera?

A

saline irrigation

46
Q

for OCD, osteoarthritis, chondromalacia, burrs are used to abrade articular defects to what level?

A

viable bleeding bone

47
Q

what structure is the landmark for locating the proper site for an anteromedial approach for ankle arthroscopy?

A

TA tendon (go medial to it)

48
Q

an anterocentral portal is always located lateral to what structure?

A

EHL

49
Q

what nerves are at risk for being injured with the anteromedial port?

A

saphenous n.

50
Q

what nerves are at risk for being injured with the anterocentral port?

A

deep peroneal n

51
Q

what nerves are at risk for being injured with the anterolateral port?

A

terminal branches of superficial peroneal n.

52
Q

what nerves are at risk for being injured with the posteromedial port?

A

tibial n.

53
Q

what nerves are at risk for being injured with the posterolateral port?

A

sural n.

54
Q

what is teh purpose of a stopcock on the sidearm of teh cannula?

A

the ingress/egress of fluids

NBPME Pearls (16 decks)

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