MCL/LCL/PLC Injuries of the Knee Flashcards

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1
Q

What is the most anterior structure that inserts on the fibular head?

A

LCL

from anterior to posterior: LCL, poplitealfibular lig, biceps femoris

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2
Q

What is the relationship of the LCL to the popliteus origin?

A

LCL insertion is proximal, posterior and superficial to popliteus

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3
Q

What exam findings are found with isolated LCL injuries? LCL and ACL/PCL? LCL and PLC?

A

Isolated LCL: varus instability at 30° only
LCL and ACL/PCL: varus instability at 0° and 30°
LCL and PLC: dial test instability at 30°

Dial test instability at 30° and 90° is PCL and PLC injury

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4
Q

LCL repair or reconstruction uses what interval?

A

Btw ITB (superior gluteal n.) and biceps femoris (sciatic n.)

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5
Q

MCL rupture usually occurs at which location?

A

Femoral insertion

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6
Q

Which injury generally occurs with a MCL tear?

A

ACL tears (up to 95%)

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7
Q

Chronic MCL injuries can have which presentation?

A

Calcification at the MFC (Pellegrini-Steida lesion)

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8
Q

Valgus laxity at 30° indicates injury to what structure(s)?

A

MCL (isolates superficial MCL)

valgus laxity at 0° indicates posteromedial capsule injury or cruciate injury

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9
Q

Prophylactic hinged knee bracing for contact athletes has shown a trend towards decreased rates for which types of injuries?

A

MCL tears

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10
Q

What are indications for operative management of MCL ruptures?

A

1) in the setting of multi-ligament knee injury
2) displaced distal avulsions with “stener-type” lesion
3) entrapment of the torn end in the medial compartment
4) Continued instability despite non-op mgmt

Otherwise treat with NSAIDs, rest, ice, PT

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11
Q

What structures make up the posterolateral corner?

A

Static: LCL, popliteus tendon, popliteofibular lig, lateral capsule, arcuate lig
Dynamic: biceps femoris, popliteus muscle, IT band, lateral head gastroc

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12
Q

What is the most anterior structure that inserts on the fibular head?

A

LCL

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13
Q

What is the dial test for?

A

PLC injuries
> 10 degrees increased laxity with external rotation at 30 degree knee flexion is isolated PLC
> > 10 degrees increased laxity with external rotation at 30 and 90 degrees knee flexion is combined PLC and PCL

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14
Q

Which exercises should be avoided in the rehab of PLC injuries?

A

Active hamstring exercises

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15
Q

What is the incidence of peroneal nerve injury in PLC repair/reconstruction?

A

15-30%

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16
Q

What must be addressed prior to any PLC reconstruction or repair?

A

Mechanical varus malalignment; higher rate of failure with varus deformity; address with HTO

17
Q

A positive reverse pivot shift test and negative posterior drawer is indicative of injury to what structure(s)?

A

PLC

18
Q

Which positive exam findings is indicative of a combined PLC and PCL injury?

A

Positive dial test at 30 and 90 degrees