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ABOS-boards > Knee/Sports > Flashcards

Knee/Sports Flashcards

1
Q

Anteromedial bundle of ACL…during extension? during flexion? When are they tight and loose?

What does posterolateral bundle prevent? When tight?

A

Anteromedial bundle During extension: fibers are parallel

During flexion: externally rotated fibers

Tight in flexion, loose in extension

Posterolateral bundle prevents pivot shift*
Prevents internal rotation with knee near extension

Tight in extension, loose in flexion***

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2
Q

Where is origin of LCL vs popliteus? Where does it insert?

When is it tight?

A

LCL originates posterior and superior to popliteus***

Inserts on fibula anterior to politeofibular ligament

Tight in extension***

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3
Q

Function of PLC?

Components of PLC?

A

Function of PLC: control external rotation and posterior translation***

Components: LCL, popliteus, poplitealfibular ligament, lateral capsule ***

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4
Q

Two components of MCL…which is more important? where does superficial originate and insert? Deep?

A

More stability from superficial MCL***

Superficial: originates SLIGHTLY PROXIMAL AND POSTERIOR to medial femoral epicondyle, inserts into periosteum of proximal tibia (deep to pes)***

Deep: Attaches to medial meniscus (coronary ligament)*
Meniscofemoral and meniscotibial components

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5
Q

Posteromedial corner function? structures?

A

function: rotatory stability

lies deep to MCL

Structures: insertion of semimembranosus
Posterior oblique ligament * –> resists tibial internal rotation in full extension*
Oblique popliteal ligament
Posterior capsule

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6
Q

What is an arcuate fx/sign and what does it represent in the knee?

A

Fx of the proximal fibula at site of insertion of the arcuate ligament complex, ass’d with curate ligament injury *** (90%)

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7
Q

What structure resists tibia internal rotation in full extension?

A

Posterior oblique ligament***

Within posteromedial corner

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8
Q

What happens if transect posterolateral bundle of ACL?

A

Increased tibial translation and rotation at 30 degrees of flexion***

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9
Q

Which mensicus is more commonly involved with discoid meniscus?

XR findings?

A

Lateral***

25% bilateral**

XR: widened joint space (up to 11 mm), squaring of lateral condyle with cupping of lateral plateau

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10
Q

Predictors of success with partial meniscectomy?

A

Younger, <40 y/o***
Normal alignment
no arthritis
Single tear

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11
Q

Approach interval for medial meniscus inside-out repair? Risk?

Approach for lateral? Risk?

A

Medial: between joint capsule and medial head of gastroc
Risk: Saphenous nerve

Lateral: IT band and biceps tendon interval, then Between lateral gastroc and joint capsule
risk: Peroneal nerve

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12
Q

Mechanism of PCL injuries?

A

Dashboard injury***

Noncontact hyper flexion injury with a plantar flexed foot***

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13
Q

What happens with chronic PCL deficiency?

A

Patellofemoral and medial compartment increased joint pressures secondary to VARUS malalignment***

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14
Q

Tx of Gr 1 and 2 PCL injuries?

If tx surgically, what technique?

What if varus mallingment?

A

Closed chain quad strengthening and prone RoM

sure: Tibial inlay/open prevents the 90 deg graft positioning of arthroscopic**

Varus: HTO with increased slope (moves tibia anteriorly to prevent posterior translation of tibia)***

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15
Q

What is most anterior structure on the fibular head?

A

LCL***

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16
Q

Where does biceps femurs insert relative to the LCL on the fibula?

A

Posterior to LCL***

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17
Q

Dial test - what test at 30 deg and 90 deg?

A

30 deg? >10 deg of ER asymmetry consistent with isolated PLC injury***

> 10 deg of ER asymmetry at 30 deg and 90 deg consistent with PLC and PCL***

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18
Q

What is primary fun of popliteus?

A

Dynamic internal rotator of tibia***

Restricts ER of tibia and posterior tibial translation

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19
Q

Where should tibial tunnel be placed for ACL?

Femoral tunnel?

A

Tibial tunnel: 10 mm anterior to PCL insertion***

9 mm posterior to interminiscal ligament**

6 mm anterior to the median eminence

Tibial tunnel: 6 mm posterior to resident’s ridge and 1.7 proximal to bifurcate ridge***

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20
Q

What patients ass’d with re-rupture of Bone patellar tendon bone autograft for ACL?

A

Patients <20***

Graft size <8 mm***

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21
Q

Which has higher load to failure - BPTB or quadrupled hamstrings?

A

Hamstring*** (4000 N vs 2600 N)

Also smaller incision, less anterior knee pain***

Less flexion strength***

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22
Q

What to avoid in rehab stage of ACL recon?

A

Open chain quad strengthening**

Isokinetic quad strengthening (15-30 deg) early in rehab***

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23
Q

What happens with too anterior of a femoral tunnel for ACL?

Posterior?

A

Too tight in flexion, loose in extension*** (don’t clear resident’s ridge)

Posterior: Tight in extension, loose in flexion

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24
Q

Tibial tunnel for ACL place too anteriorly?

Too posterior?

A

too anteriorly: impingement in extension, too tight in flexion

Posterior: will impinge on PCL

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25
Q

Describe Pivot shift, in full extension and with flexion/valgus/internal rotation - when sublimated and when reduced?

A

In ACL deficient knee in full extension the lateral plateau sublimates ANTERIORLY***

With valgus applied, the lateral pleated impinges on the lateral condyle

As knee flexed, lateral plateau SLIDES POSTERIORLY into a REDUCED POSITION*** –> clunk

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26
Q

Bone bruises of ACL tear?

A

Lateral femoral condyle and posteriolateral tibia***

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27
Q

Genotype ass’d with ACL tears?

A

COL5A1***

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28
Q

What is secondary restraint to anterior tibial displacement after ACL?

A

Posterior horn of medial meniscus***

Thought to limit by acting as buttress by wedging against the posterior aspect of the medial femoral condyle**

29
Q

What happens in ACL deficient knee at terminal swing phase?

A

Lacks the normal internal rotation of the femur in terminal swing***

30
Q

At what ROM do seated leg extension place highest amount of stress on ACL?

A

0-30 degrees

31
Q

Most common failure of ACL?

A

Misplaced tunnel

Most common misplaced tunnel: Too anterior on femoral tunnel = tight in flexion, loose in extension***

32
Q

What is the greatest risk factor for progression of OA with ACL tear?

A

Meniscus pathology ***

No real diff in ACL recon vs ACL deficient, so meniscus is the big factor

33
Q

Where does LCL tear from?

A

Generally tears from FIBULAR insertion**

34
Q

What is miserable triad of patellofemoral dysplasia?

A

Femoral anteversion*
Genu valium*
External tibial torsion/pronated feet***

35
Q

What TT-TG distance is indication for osteotomy?

A

> 20 mm***

36
Q

What is normal Q angle in female?

A

17 degrees***

37
Q

Definition of patella Alta in terms of Insall-Salvati ratio?

Baja?

A

> 1.2* (with knee flexed to 30 degrees)

Baja: <0.8***

38
Q

MPLF femoral origin?

A

Between medial epicondyle and adductor tubercle***

Primary restraint to lateral motion of patella in first 20 degrees of knee flexion

39
Q

Where is most common site for osteochondral fragment after patella dislocation?

A

Medial patellar facet**

40
Q

Who does Spontaneous Osteonecoris of Knee (SONK) affect?

Where?

How many joints?

A

Mainly FEMALES, middle age and elderly***

Usually epiphysis of MEDIAL FEMORAL CONDYLE***

99% of patients have one joint affected

41
Q

Jumpers knee - what is it?

Who does it affect?

A

Activity related anterior knee pain ass’d w/ focal patellar tendon tenderness***

Risk factors:
Males > females***
Volleyball most common
Poor quadriceps and hamstring flexibility

42
Q

Algorithm for cartilage defect treatment….

Femoral condyle treatment for <4cm2 vs >4cm2?

Patellofemoral treatment for <4cm2 vs >4cm2?

A

Femoral condyle treatment:
<4cm2: Microfracture of osteochondral autograft transfer
>4cm2: Osteochondral allograft or autologous chondrocyte implantation

Patellofemoral treatment:
<4cm2: Microfracture of osteochondral autograft transfer
>4cm2: Autologous chondrocyte implantation

43
Q

What is a contraindication to a Fulkerson/TTO?

A

Superior medial patellar arthritis***

Scope before surgery

44
Q

Contraindication to ACI?

A

Joint space narrowing*
Relies on intact, full-thickness cartilage margins to maintain he joint space so growing cartilage repair tissue may fill he defect*

Malalignment is NOT a contraindication (can do HTO, etc)

45
Q

What is most common location for ostechondritis dissecans?

Prognosis?

A

Most common: Posterolateral aspect of MFC (70% of lesions in knee)***

Capitellum
Talus

Prognosis correlates with:
Age: younger do better, open distal femoral phases are the BEST PREDITOR of successful nonop tx *
Location: lateral femoral condyle and patella do worse
Appearance: sclerosis on XR or fluid behind lesion on MRI = poor prognosis**

46
Q

ASIS avulsion - what muscles?

A

Sartorius* (femoral n.)
TFL* (Sup gluteal nerve)

Happens during hip extension** (sprinting or swinging a baseball bat)

47
Q

How to diagnose internal snapping hip (on imaging)?

A

Ultrasound***

Most common in dancers

48
Q

Which hamstring muscle has the most lateral origin at ischial tuberosity?

Innervation of hamstrings?

A

Semimembranosus is most lateral origin***

Innervation:
Semimembranosus, semitendinosus and long head of biceps: tibial
Short head: Common peroneal nerve

49
Q

What is role of satellite cells?

A

Regenerate skeletal muscle after muscle injury***

50
Q

Where would see instability if only Posterolateral bundle of ACL is transected?

A

Increased tibial translation AND rotation at 30 DEGREES of flexion***

Think pivot shift

51
Q

Who gets Cam impingement?

Where does it occur on femoral neck?

What characterizes it?

A

Who gets: young athletic males***

Occurs on anterolateral neck***

Characteristics:
Decreased head:neck ratio***
aspherical femoral head***
Decreased femoral offset***
Femoral neck retroversion***
52
Q

Who gets pincer impingement?

Where does it occur?

A

Who gets: active middle aged women

Occurs in anterosuperior quadrant***

53
Q

What is false profile view show? How to take it?

A

Shows anterior coverage of femoral head for FAI

To get; standing position at an angle of 65 deg between the pelvis and film***

54
Q

How long until patient can get back to athletic activities after open surgical hip dislocation?

A

7 months***

55
Q

FADIR test detects what?

A

FAI***

56
Q

What are the portals for hip arthroscopy? What are risks?

A

Anterolateral portal
-Primary viewing portal
-2 cm anterior and superior to GT, done first under flour
At risk: Superior gluteal nerve***

Anterior portal
-Usually done 2nd
Intersection of GT and line from ASIS
Flexion and IR loosens capsule to allow scope insertion
-Make capsulotomy between anterior and anterolateral portal* (iliofemoral ligament cut)
At risk: LFCN*, NV bundle, ascending branches of lateral femoral circ artery

Distal anterolateral
-Access to peripheral compartment of femoral neck
-start 3-5 cm distal to anterolateral portal
-do under direct visualization or fluoro
At risk: ascending branch of lateral femoral circumflex artery

Mid anterior portal
similar to anterior portal

Posterorlateral portal
-posterior hip joint access
-1 cm posterior and 1 cm proximal to posteriorsupesior tip of GT
At risk: Sciatic

57
Q

What does zona orbicularis act as landmark for during hip arthroscopy?

A

Landmark for iliopsoas tendon***

58
Q

What medication has been shown to improve skeletal muscle regeneration and decrease fibrosis following muscle injury in animal model?

A

Losartan***

Angiotensin II receptor blockade**

59
Q

Femoral neck stress fx - which to fix?

A 
Tension sided (superior neck)***
Compression sided (inferior neck) when >50%***
60
Q

What is most common bone involved in stress fx in athletes?

A

Tibia*** (anterior shaft, tension side)

61
Q

What does D test test for?

A

Clindamycin inducible resistance by MRSA***

Change to doxy***

62
Q

Endurance training increases what in athlete?

A

Increase type 1 muscle fibers** (not type II)

Greater use of lipid reduces contribution to carb to ATP resynthesis, so increased storage and utilization of intramuscular lipids ***

63
Q

phases of Energy source for muscles…Anaerobic v glycolytic vs aerobic

E source?
Muscle type?
exercise duration?

A

Anaerobic
E source: ATP-CP*
Mucscle type: Type II (A, B)/fast twitch
Type IIA: aerobic AND anaerobic
Type IIB: Primarily anaerobic, LAST to be recruited ***
Duration: 10 seconds

Glycolytic
E source: Lactic acid
Duration: 2-3 minutes

Aerobic
E source: Oxidative phohsphorylation/Krebs
Glycogen and fatty acids***
Muscle type: Type 1/slow twitch**
FIRST to be recruited ***
Duration: endurance
64
Q

Type I vs type II fibers

A

Type I: slow oxidative, first to be recruited***

Type II: Fast oxidative/glycotlytic (type IIA) and fast glycolytic (type IIB)
Type IIB last recruited***

65
Q

Isotonic exercise?

A

Constant MUSCLE TENSION**

66
Q

Closed chain exercises?

A

use compressive nature of applied loads***

67
Q

Sports that rely on what movements contribute to athletic pubalgia?

A

Sports that focus on ABDUCTION and HIP EXTENSION***

aka: sports hernia***

Extension/abduction of the leg w/ eccentric contraction of the adductors leads to high shear on recturs –> causes tears in transversals fascia, rectus and/or adductor Magnus origin***

Tx: nonop for 6-8 wks, then consider OR

68
Q

Positive factors for healing meniscus repair?

A

Positive:
Red zone tear
SMALL rim width * (width from peripheral meniscocapsular junction, so smaller = better vascularity)
VERTICAL and LONGITUDINAL tears***

69
Q

Primary stabilizer for valgus stress for knee in extension? flexion?

A

Extension valgus stabilizer = Posteromedial corner***

Flexion: superficial MCL***

ABOS-boards (11 decks)

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