L12 LE Surgeries Flashcards

Question

Low demand/functional instability patients

Answer 1

soft tissue allograft

Answer 2

quad outcomes equal less morbidity

Answer 3

most common ligamentous injury valgus stress w/knee in flex and ER proximal tears more common often associated with ACL tear

Answer 4

has poor healing capacity

Answer 5

primary valgus restraint at all angles, greatest in 30° flexionD

Answer 6

secondary stabilizer, greatest in full extension

Answer 7

valgus stress, medial pain, maybe swelling instability with WB laxity w/valgus stress, increased laxity in full ext

Answer 8

almost always non-operative grade 1 = nsaids, rest, RTP 1-2 weeks grade 2 = bracing, RTP 4-6 weeks grade 3 = bracing 4 wks, RTP 8-12

Answer 9

chronic laxity (grade 3) full distal tears or flipped proximal multigamentous injuries

Answer 10

acute grade 3 w/multi ligament displaced distal avulsion entrapped in joint

Answer 11

chronic injury loss of good tissue gold standard in most cases

Answer 12

always traumatic fall with knee in HE, foot PF presents with posterior instability often associated with PLC

Answer 13

posterior sag sign posterior drawer (most accurate) dial test (for PLC)

Answer 14

isolated tears bracing, protected WB, rehab

Answer 15

isolated grade 3 in young athletes multigamentout injuries displaced avulsion fx chronic instability

Answer 16

for acute and avulsion injuries

Answer 17

chronic, significant tissue loss

Answer 18

sudden varus force to knee isolated is very rare, often with PLC LCL is tight in extension, lax in flexion

Answer 19

instability near full ext difficulty with stairs lateral pain/swelling tender over LCL hyperextension/varus thrust

Answer 20

isolated grade 1 or 2 bracing, progressive ROM, functional rehab RTP by 6-8 weeks

Answer 21

Need to prove that you need it treat all isolated with non-op reconstruct who needs it fix/repair displaced avulsion fx reconstruct LCL/PLC injuries rate of failure is very high

Answer 22

traumatic or degenerative most common indication for knee surgery higher risk in ACL tears b/c they become stabilizers medial more common that lateral except with ACL injuries

Answer 23

vertical/longitudinal bucket handle oblique/flap/parrot radial horizontal complex root

Answer 24

common with ACL tears

Answer 25

progression of vertical tear locked knee

Answer 26

often cause mechanical symptoms

Answer 27

full thickness tears rapid arthritis

Answer 28

common in older population associated with meniscal cysts

Answer 29

usually chronic, degernative

Answer 30

functionally equivalent to total meniscectomy

Answer 31

-twisting, immediate focal pain -delayed effusion -pain S/S with pivoting, deep flexion, squat -possible effusion -joint line tenderness -pain with high flexion

Answer 32

first line for degenerative tears outcomes equivocal to menisectomy stable apearing tears in red zone NSAIDs, PT do NOT use PRP

Answer 33

unstable tears, mechanical S/S acute tears in young pts root tear buckethandle tear

Answer 34

middle aged, overweight pop in posterior knee severe pain, swelling, instability aggressive surgical indications, conservative tx will not heal this

Answer 35

young, healthy patient with subtotal meniscectomy no or minimal degenerative changes address concomitant pathology like ACL, cartilage, malalignment

Answer 36

made mostly of water and type 2 collagen, proteogylcans, chondrocytes helps to decrease friction and distribute load

Answer 37

located in menisci, and is made of fibrous cartilage, type 1 collagen, some proteoglycans, chondrocytes healing response to injury of articular cartilage. Compressive strength

Answer 38

pathologic lesoin affecting articular cartilage and subchondral bone present in juvenile or adult, most common in the knee can be heriditary, traumatic, vascular

Answer 39

1. softening of overlying articular cartilage 2. early articular cartilage separation 3. partial detachment of lesion 4. osteochondral separation with loose bodies

Answer 40

activity related pain, vague, poorly localized mechanical symptoms--unstable lesion, advanced disease recurrent knee effusions use MRI to diagnose advanced disease

Answer 41

size status of bone stability of lesion loose bodies

Answer 42

1 = small area, compression on subchondral bone 2 = partially detached fragment 3 = fully detached, still in crater 4 = complete detachment/loose body

Answer 43

stable lesions, open physes asymptomatic lesions in adults restricted WB with bracing up to 3 mo 50-75% will heal

Answer 44

unstable lesions, impending physeal closure, expanding lesions on XR, failed non-op options include subchondral drilling, fixation of lesion >2 cm, chondral resurfacing, arthroplasty

Answer 45

correlates with age, location, appearance open physes is best predictor of successful nonoperative tx medial femoral condyle is better adult OCD, sclerosis on x rays and fluid behind lesion on MRI is worse

Answer 46

patient <50 yo, BMI <35, with lesions up to 15 mm transfer of healthy cartilage from NWB area to the lesion

Answer 47

for large lesions too large for autograft fresh sterilized cadaver that is pt match not useful in OA, bipolar lesion, inflammatory arthropathy, >50 years, smoking/alcohol abuse

Answer 48

sick cartilage, most often seen on patella and causes ant knee pain most common in adolescents, young adults, women

Answer 49

roughening/damage to patellar cartilage mult-factorial: muscle weakness, anatomy, patellar maltracking. Basically elevated PF contract pressures miserable malalignment syndrome

Answer 50

femoral anteversion, genu valgum, external tibial torsion, increased Q angle

Answer 51

retropatellar pain, often radiates post insidious, chronic, vague pain w/stairs, prolonged sitting, squat quad atrophy, positive J sign, lateral patellar sublux, crepitus, pain with patellar compression with ROM

Answer 52

X-ray = shallow sulcus, patellar tilt MRI = assess cartilage, trochlear dysplasia, patellar tracking, rotation

Answer 53

almost always first line tx min 6 mo before considering surgical intervention avoid steroids rehab focusing on core, posterior chain, hip ER, closed chain quad, flexibility

Answer 54

cartilage = chondroplasty, microfx alignment = lateral elngthening, patellar realignment trochlear deepening

Answer 55

for full thickness chondral defects up to 8 cm patient harvested chondrocytes cultured and grown on film implanted back into defect excellent outcomes in appropriate patients

Answer 56

tibial tubercle osteotomy for patellar instability increasingly more popular for chondromalacia idea is to offload diseased area, improve tracking

Answer 57

degenerative process causing progressive loss of articular cartilage pain at rest, activity induced swelling, stiffness, instability, mechanical

Answer 58

Grade 0 = no OA Grade 1 = minute osteophyste Grade 2 = definite osteophyte, normal joint space Grade 3 = some joint space reduction Grade 4 = joint space greatly reduced

Answer 59

rehab, education, wellness NSAIDs weight loss program bracing

Answer 60

viscosupplementation (works with 60%) corticosteroid injections (doesn't work with activity based pain) orthobiologics like PRP

Answer 61

High tibial osteotomy Unincomportmental arthroplasty Total knee arthroplasty

Answer 62

young, active, healthy patients isolated OA with varus malalignment many contraindications

Answer 63

older, low demand, health pts unicompartmental disease many contraindications has faster rehab, less morbid, preservation of normal kinematics. Has high loosening rate and stress fx not many patients meet the criteria

Answer 64

most people do great 15-20% of people have pain with no physiologic explanation survival rates of at least 80% at 20 years arthroscopic debridement is not recommended. Could make it worse and 50/50 chance success