Chapter 48 - Non-arthroplasty Surgical Treatment of the Knee

Question 1

when are arthroscopic knee procedures contraindicated?

Answer 1

advanced osteoarthritis, especially in the presence of varus/valgus deformities

Question 2

good prognostic factors for burner knee scope

Answer 2

1. increased pain after an ACUTE event with injury mechanism/mechanical sx
2. recent effusion
3. loose bodies, normal mechanical alignment
4. isolated chondral flap, isolated/focal meniscal tear, unicompartmental ds

Question 3

poor prognostic factors for a burner knee scope

Answer 3

1. workers com, litigation
2. varus/valgus alignment
3. diffuse disease, degen meniscal tears/non-focal, multicompartmental disease

Question 4

what type(s) of collagen is reparative cartilage made up of

Answer 4

fibrocartilage - type I and II collagen although type I predominates

(but you cannot say “ONLY” type I bc some type II is there too - I’ve gotten this question wrong)

Question 5

What osteotomy to perform for varus limb alignment?

Answer 5

medial compartment arthritis

perform tibial osteotomy

Question 6

when to perform high tibial osteotomy

Answer 6

varus knee alignment with medial compartment arthritis

Question 7

types of high tibial osteotomy: lateral closing wedge

Answer 7

disadvantages:
1. need to perform concomitant fibular osteotomy
2. higher risk of peroneal nerve injury
3. risk of damage to th eproimal tibiofibular joint

advantage: increased rates of union

Question 8

types of high tibial osteotomy: medial opening wedge

Answer 8

disadvantages:
1. risk of non-union
2. risk of collapse/loss of correction
3. need for bone graft

Question 9

when to perform a distal femoral osteotomy?

Answer 9

VALGUS deformity of the knee (eg this is a varus producing osteotomy)

Question 10

what type of osteotomy do you perform in valgus knee alignment

Answer 10

medial closing wedge distal femoral osteotomy

results in a horizontal tibiofemoral joint

Question 11

when to use tibial vs femoral osteotomy?

Answer 11

femoral
- valgus alignment (medial closing wedge)

tibial
- varus knee alignment
- can do lateral closing wedge OR medial opening wedge

Question 12

Indications for microfracture

Answer 12

• lesions <1cm^2

Question 13

Indications for OATS

Answer 13

lesions 1-2cm
donor site: superolateral intercondylar notch of the femur, or medial aspect of the trochlea superior to sulcus terminalis

Question 14

indications for osteochondral allograft?

Answer 14

large defects >4cm

Question 15

position of knee fusion if LLD <2cm

Answer 15

5-7degrees of valgus
15deg flexion

Question 16

position of knee fusion if LLD 2-4cm

Answer 16

straight extension to enable ground clearance

Question 17

position of knee fusion if LLD is >4cm

Answer 17

consider bone grafting/prosthetic spacer to limit gait abnormalities