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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
Describe Pivot shift, in full extension and with flexion/valgus/internal rotation - when sublimated and when reduced?
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
26
Bone bruises of ACL tear?
Lateral femoral condyle and posteriolateral tibia***
27
Genotype ass'd with ACL tears?
COL5A1***
28
What is secondary restraint to anterior tibial displacement after ACL?
Posterior horn of medial meniscus*** Thought to limit by acting as buttress by wedging against the posterior aspect of the medial femoral condyle**
29
What happens in ACL deficient knee at terminal swing phase?
Lacks the normal internal rotation of the femur in terminal swing***
30
At what ROM do seated leg extension place highest amount of stress on ACL?
0-30 degrees
31
Most common failure of ACL?
Misplaced tunnel Most common misplaced tunnel: Too anterior on femoral tunnel = tight in flexion, loose in extension***
32
What is the greatest risk factor for progression of OA with ACL tear?
Meniscus pathology *** No real diff in ACL recon vs ACL deficient, so meniscus is the big factor
33
Where does LCL tear from?
Generally tears from FIBULAR insertion**
34
What is miserable triad of patellofemoral dysplasia?
Femoral anteversion*** Genu valium*** External tibial torsion/pronated feet***
35
What TT-TG distance is indication for osteotomy?
>20 mm***
36
What is normal Q angle in female?
17 degrees***
37
Definition of patella Alta in terms of Insall-Salvati ratio? Baja?
>1.2*** (with knee flexed to 30 degrees)** Baja: <0.8***
38
MPLF femoral origin?
Between medial epicondyle and adductor tubercle*** Primary restraint to lateral motion of patella in first 20 degrees of knee flexion
39
Where is most common site for osteochondral fragment after patella dislocation?
Medial patellar facet**
40
Who does Spontaneous Osteonecoris of Knee (SONK) affect? Where? How many joints?
Mainly FEMALES, middle age and elderly*** Usually epiphysis of MEDIAL FEMORAL CONDYLE*** 99% of patients have one joint affected
41
Jumpers knee - what is it? Who does it affect?
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
Algorithm for cartilage defect treatment.... Femoral condyle treatment for <4cm2 vs >4cm2? Patellofemoral treatment for <4cm2 vs >4cm2?
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
What is a contraindication to a Fulkerson/TTO?
Superior medial patellar arthritis*** | Scope before surgery
44
Contraindication to ACI?
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
What is most common location for ostechondritis dissecans? Prognosis?
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
ASIS avulsion - what muscles?
Sartorius*** (femoral n.) TFL*** (Sup gluteal nerve) Happens during hip extension** (sprinting or swinging a baseball bat)
47
How to diagnose internal snapping hip (on imaging)?
Ultrasound*** Most common in dancers
48
Which hamstring muscle has the most lateral origin at ischial tuberosity? Innervation of hamstrings?
Semimembranosus is most lateral origin*** Innervation: Semimembranosus, semitendinosus and long head of biceps: tibial Short head: Common peroneal nerve
49
What is role of satellite cells?
Regenerate skeletal muscle after muscle injury***
50
Where would see instability if only Posterolateral bundle of ACL is transected?
Increased tibial translation AND rotation at 30 DEGREES of flexion*** Think pivot shift
51
Who gets Cam impingement? Where does it occur on femoral neck? What characterizes it?
Who gets: young athletic males*** Occurs on anterolateral neck*** ``` Characteristics: Decreased head:neck ratio*** aspherical femoral head*** Decreased femoral offset*** Femoral neck retroversion*** ```
52
Who gets pincer impingement? Where does it occur?
Who gets: active middle aged women Occurs in anterosuperior quadrant***
53
What is false profile view show? How to take it?
Shows anterior coverage of femoral head for FAI To get; standing position at an angle of 65 deg between the pelvis and film***
54
How long until patient can get back to athletic activities after open surgical hip dislocation?
7 months***
55
FADIR test detects what?
FAI***
56
What are the portals for hip arthroscopy? What are risks?
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
What does zona orbicularis act as landmark for during hip arthroscopy?
Landmark for iliopsoas tendon***
58
What medication has been shown to improve skeletal muscle regeneration and decrease fibrosis following muscle injury in animal model?
Losartan*** Angiotensin II receptor blockade**
59
Femoral neck stress fx - which to fix?
``` Tension sided (superior neck)*** Compression sided (inferior neck) when >50%*** ```
60
What is most common bone involved in stress fx in athletes?
Tibia*** (anterior shaft, tension side)
61
What does D test test for?
Clindamycin inducible resistance by MRSA*** Change to doxy***
62
Endurance training increases what in athlete?
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
phases of Energy source for muscles...Anaerobic v glycolytic vs aerobic E source? Muscle type? exercise duration?
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
Type I vs type II fibers
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
Isotonic exercise?
Constant MUSCLE TENSION****
66
Closed chain exercises?
use compressive nature of applied loads***
67
Sports that rely on what movements contribute to athletic pubalgia?
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
Positive factors for healing meniscus repair?
Positive: Red zone tear SMALL rim width *** (width from peripheral meniscocapsular junction, so smaller = better vascularity***) VERTICAL and LONGITUDINAL tears****
69
Primary stabilizer for valgus stress for knee in extension? flexion?
Extension valgus stabilizer = Posteromedial corner*** Flexion: superficial MCL***

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