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PC Sports > PC Knee > Flashcards

PC Knee Flashcards

1
Q

Q angle

A

Angle btw line from ASIS to centre of patella to tibial tubercle

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2
Q

J sign patella

A

excessive lateral translation in extension which “pops” into groove as the patella engages the trochlea early in flexion —-associated with patella alta

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3
Q

Most sensitive test to detect combined ACL & MCL tear

A

Anterior drawer test with tibia in EXTERNAL rotatoin

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4
Q

Segond sign

A

Small lateral tibial avulsion fracture that indicates a ACL tear

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5
Q

Reverse Segond sign

A

Small medial tibial avulsion fracture that indicates a PCL tear

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6
Q

Arcuate sign

A

Fibular head avulsion fracture that indicates a PLC injury

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7
Q

Pellegrini Stieda sign

A

Medial femoral condyle avulsion fracture that indicates a chronic MCL injury

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8
Q

Patella alta

A

Patellofemoral pathology

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9
Q

Patella baja

A

Arthrofibrosis

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10
Q

Fairbanks changes

A

DJD - post meniscectomy (square condyle, peak eminences, ridging, narrowing)

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11
Q

Lateral MFC lesion

A

OCD

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12
Q

Crescent-shaped MFC lesion

A

Spontaneous osteonecrosis of the knee (SONK)

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13
Q

Square lateral femoral condyle, cupped lateral tibial plateau, hypoplastic lateral tibial spine

A

Discoid meniscus

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14
Q

Main secondary stablizer to anterior translation of the tibia

A

Posterior horn of the medial meniscus

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15
Q

Type of collagen and % in the meniscus

A

90% Type I collagen

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16
Q

Ligamentous attachements of the menisci

A

– transverse (intermeniscal) ligament
connects the medial and lateral meniscus anteriorly
– coronary ligaments
connects the meniscus peripherally
medial meniscus has less mobility with more rigid peripheral fixation than the lateral meniscus
– meniscofemoral ligament
connects the meniscus into the substance of the PCL
originate from the posterior horn of the lateral meniscus and has two components
Humphrey ligament (anterior)
Ligament of Wrisberg (posterior)

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17
Q

How to menisci heal?

A

Tears in peripheral 25% can heal

Heal via fibrocartilage scar

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18
Q

Blood supply to meniscus:

A

Middle genicular artery — posterior horns of MM/LM

Medial inferior genicular a — peripheral MM

Lateral inferior genicular a –> peripheral LM

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19
Q

Most sensitive test to detect meniscal tear

A

Joint line tenderness

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20
Q

First line treatment for degenerative meniscal tear

A

Nonop

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21
Q

Indications for partial meniscectomy

A
    • tears not amenable to repair (complex, degenerative, radial tear patterns)
    • repair failure >2 times
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22
Q

Indications for meniscal repair

A
    • peripheral tear
    • lower rim width (distance at periphreal meniscocapsular junction)
    • vertical or longitudinal tear
    • small (1-4 mm in length)
    • acute repair combined with ACL recon
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23
Q

Indications for meniscal transplant

A

– young pts with near-total meniscectomy, especially lateral

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24
Q

Contraindications for mensical transplantatoin

A
    • inflammatory arthritis
    • instability
    • marked obesity
    • grade IV chondrosis
    • malalignment
    • diffuse arthritis
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25
Q

Criteria for meniscal transplant

A
    • Age < 50
    • BMI < 30
    • Pain in the tibiofemoral joint
    • 2 mm or more in the tibiofemoral joint space on Rosenberg
    • Ligamentous stability
    • Normal alignment
    • No XR evidence of advanced arthrosis
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26
Q

Interval for inside-out MEDIAL meniscal repair

A

Incise sartorius fascia
Retract pes tendons/semimembranosus posteriorly
Develop plane btw the medial gastroc and capsule

** risk = saphenous vein and nerve **

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27
Q

Interval for inside-out LATERAL meniscal repair

A

Develop plane btw IT band and biceps tendon
Retract lateral head of gastroc posteriorly

** risk = peroneal nerve **

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28
Q

Best stitch type for fixation of mensical repairs

A

Vertical mattress sutures are strongest bc capture circumferential fibers

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29
Q

Most common complication after meniscal transplant

A

Mensical graft tear

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30
Q

Perimeniscal cyst (cyst within the meniscus)

A

Meniscal tear

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31
Q

Watanabe classification

A

Type 1 - Complete discoid meniscus
Type 2 - Incomplete discoid meniscus
Type 3 - Wrisberg (lack of posterior meniscotibial attachment to tibia) — d/t hypermobility, higher risk for tears

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32
Q

XR findings in discoid meniscus

A

widened joint space (up to 11mm)
squaring of lateral condyle with cupping of lateral tibial plateau
hypoplastic lateral intercondylar spine

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33
Q

Treatment of discoid meniscus - asympotmatic

A

Observation

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34
Q

Indicatoins for surgery for discoid meniscus

A
    • pain and mechanical symptoms

- - meniscal tear or meniscal detachment

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35
Q

Most common injury associated with ACL tear

A

Lateral meniscal tear (54%)

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36
Q

Female ACL injuries versus male ACL injuries

A
  1. 5:1 F:M ratio
    - - Antatomic: impingment, smaller ACL, hypermobility
    - - Biomech: increased valgus/extension at landing, decreased knee/hip flexion, fatigue
    - - Neuromusc: lower hamstring:quad radio (more quad dominant), weaker core stability
    - - Hormonal
    - - Genetic: collagen production
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37
Q

Anterior edge of ACL origin on femur

A

Lateral intercondylar ridge of femur

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38
Q

Line that separates anteromedial and posterolateral budle attachements of ACL on femur

A

Bifurcate ridge

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39
Q

ACL blood supply

A

Middle geniculate artery

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40
Q

Location of bone bruises in acute ACL tears

A

middle 1/3 of LFC (sulcus terminalis)
posterior 1/3 of the lateral tibial plateau
subchondral changes on MRI can persist years after injury

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41
Q

Indications for ACL reconstruction

A
    • younger, more active patients (reduces the incidence of meniscal or chondral injury)
    • children (strongly consider operative as activity limitation is not realistic)
    • older active patients (age >40 is not a contraindication if high demand athlete)
    • prior ACL reconstruction failure
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42
Q

Timing of treatment in ACL with MCL injury

A

allow MCL to heal (varus/valgus stability) and then perform ACL reconstruction
varus/valgus instability can jeopardize graft

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43
Q

Timing of treatment in ACL with meniscal tear

A
    • perform the meniscal repair at the same time as ACL reconstruction
    • increased meniscal healing rate when repaired at the same time as ACL
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44
Q

Timing of treatment of ACL with posterolateral corner injury

A

– reconstruct at the same time as ACL or as 1st stage of 2 stage reconstruction

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45
Q

Location of ACL tibial tunnel placement

A

10-11mm in front of the anterior border of PCL insertion

6mm anterior to the median eminence

9mm posterior to the inter-meniscal ligamen

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46
Q

Pros/cons of bone-patellar-bone autograft for ACL reconstruction

A
    • the longest history of use and considered the “gold standard”
    • bone to bone healing
    • ability to rigidly fix the joint line (screws)
    • the highest incidence of anterior knee pain (up to 10-30%)
    • maximum load to failure is 2600 Newtons (intact ACL is 1725 Newtons)
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47
Q

Complications in BTB ACL reconstruction

A

Patella fracture
Patellar tendon rupture
Re-rupture (associated with age < 20 and graft size < 8mm)

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48
Q

Pros/cons of hamstring autograft for ACL reconstruction

A
    • smaller incision, less perioperative pain, less anterior knee pain
    • fixation strength may be less than Bone-PT-Bone
    • maximum load to failure is approximately 4000 Newtons
    • decreased peak flexion strength at 3 years compared to Bone-PT-Bone
    • concern about hamstring weakness in female athletes leading to increased risk of re-rupture
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49
Q

Best determinant of skeletal maturity in females

A

Menarche

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50
Q

Factors that lead to physeal injury during pediatric ACL reconstruction

A
    • large tunnel diameter (>12mm) is most important
      - - 8mm tunnel corresponds to <3% physeal cross-sectional area
      - - 12mm tunnel corresponds to >7-9% of physeal cross-sectional area is violated
    • oblique tunnel position
    • interference screw fixation
    • high-speed tunnel reaming
    • lateral extra-articular tenodesis
    • dissection close to the perichondral ring of LaCroix
    • suturing near tibial tubercle
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51
Q

Postop ACL rehab focuses/avoidances

A 
Eccentric strenghtening at 3 wks
Closed chain (foot planted) exercises

AVOID: isokinetic quad strengthening, open chain quad strengthening

Lowest ACL strain with isometric hamstring at 60-90 degrees flexion; or quad+ham at that amount

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52
Q

Most common cause of failure after ACL

A

Improper tunnel position

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53
Q

Problem with vertical femoral tunnel placement

A

Rotational instability that can be identified with pivot shift test

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54
Q

Problem with too anterior femoral tunnel placement in ACL

A

Knee is tight in flexion & loose in extension

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55
Q

Problem with too posterior femoral tunnel placement in ACL

A

Knee is lax in flexion & tight in extension

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56
Q

Problem with tibial tunnel that is too anterior in ACL recon

A

Knee is tight in flexion with impingement in extension

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57
Q

Problem with tibial tunnel that is too posterior in ACL recon

A

ACL will impinge with the PCL

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58
Q

Treatment septic arthritis in ACL reconstruction

A

Most common bug is S. epidermidis

Tx: Immediate arthroscopic I&D

Can often retain graft with multiple I&Ds and abx (6 wks minimum)
Better success with graft retention with S. epideridimis than S. aureus

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59
Q

Reduced gene expression associated with increased risk of ACL rupture in women

A

COL5A1

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60
Q

Most common nerve injured in autologous ACL reconstruction

A

Infrapatellar branch of the saphenous nerve — provides sensation over the anterolateral infra-patellar area of the leg

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61
Q

In ACL deficient knee, what gait parameters are lost

A
    • absence of normal femoral internal rotation during terminal swing phase
    • decreased anterior translation of the tibia in late swing phase
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62
Q

Critical angle over which graft-screw divergence increases risk of ACL failure

A

15-30 degrees — most commonly seen in the femur

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63
Q

Provides the most important restraint to anterior tibial translation in the ACL-deficient knee

A

Posterior horn of the medial meniscus

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64
Q

Mechanism of PCL injury

A
    • direct blow to proximal tibia with flexed knee (dashboard injury)
    • noncontact hyperflexion with plantar-flexed foot
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65
Q

Long term effect of chronic PCL deficiency

A

– increased contact pressures in PFJ and medial compartment d/t varus alignment

66
Q

Blood supply to PCL

A

Middle geniculate artery

67
Q

Treatment of grade I/II PCLs

A

Nonop: protected WB & rehab — quad rehab with focus on knee extensor strengthening; return to sports in 2-4 wks

68
Q

Treatment of grade III PCLs

A

Nonop: extension bracing with limited daily ROM execises; imobilizaiton followed by quad strengthening

69
Q

Indications for surgery for PCL injuries

A
    • Mulitligamentous knee injury
    • grade II/III injuries with bony avulsion
    • Isolated chronic PCL with functionally unstable knee
70
Q

Treatment of chronic PCL deficiency

A

Medial opening wedge osteotomy

71
Q

Mechanism of LCL injury

A

Most frequenly from MVAs or athletic injuries — direct blow or force on weight bearing knee — excessive varus stress, tibial ER and/or hyperextension

Rarely isolated injury; usually w other ligs (esp posterolateral corner injury)

72
Q

Order of structures inserting on the proximal fibular head (posterolateral corner)

A

LCL –> popliteofibular ligament –> biceps femoris

73
Q

Origin and insertion of LCL

A

Origin: lateral femoral condyle; posterior & proximal to popliteus

Insertion: Anterolateral fibular head; most anterior structure on prox fibula

74
Q

Blood supply to the LCL

A

Superolateral and inferolateral geniculate arteries

75
Q

Varus stress test findings at 0 and 30

A

opens at 0 & 30 — LCL + ACL/PCL

opens at 0 only — LCL only

76
Q

Indications for nonop treatment of LCL injury

A

Isolated grade I or II injury (no instability at 0)

77
Q

Nonop treatment of LCL injuries

A

Isolated grade I or II injury (no instability at 0)

Limited immobilization, progressive ROM & fnl rehab

Return to sport in 6-8 wks

78
Q

Operative treatment of LCL injuries

A

Indiations: grade III LCL injury; PLC injury; ACL/PCL injury

Repair vs reconstruction +/- PLC/ACL/PCL recon

Better outcomes with acute repair

79
Q

Primary restraints to rotational motion in the knee

A

The LCL, popliteus tendon, and popliteofibular ligament

80
Q

Funciton of posterolateral corner

A

Popliteus works with PCL to control tibial ER, varus, & posterior translatoin of tibia

Popliteus & popfib lig function maximally in knee flexion to resist ER

LCL primary restraint to varus at 5 and 25 degrees knee flexion

81
Q

Dial test

A

> 10 deg ER asymmetry at 30 deg only = isolated PLC injury

> 10 deg ER asymmetry at 30 & 90 deg = PLC + PCL injury

82
Q

Nonop treatment of posterolateral corner injuries

A

Indications: grade I PLC; isolated grade 2 injury

HKB x 4wks, functional rehab, quad strengthening, return to sports at 8 wks

83
Q

Operative treatment of PLC injuries

A

PLC repair = isolated acute grade 2 injuries

PLC recon = grade III midsubstance injuries

84
Q

Larson (fibular based) PLC reconstruction

A
    • soft tissue graft passed through bone tunnel in fibular head
    • limbs are then crossed to create figure-of-eight and fixed to lateral femur to a single tunnel
85
Q

Valgus HTO in PLC tear

A

indicated in patients with varus mechanical alignment

failure to correct bony alignment jeopardizes ACL and PLC reconstruction success

86
Q

Outcomes PLC ligament repair vs reconstruction

A

Reconstructions have less revision rates and better outcome scores

87
Q

Risk factors for developing patellar tentinitis

A
    • males > females
    • volleyball most common
    • more common in adolescents & young adults
    • poor quad/hamstring flexibilty
88
Q

Nonop treatment of patellar tendintis

A

ice, rest, activity modification, followed by PT

NO cortisone injections (tendon rupture)

89
Q

Indication for surgery in patellar tendintis

A

– Pain at all times that is not amenable to conservative tx
– Partial tears
Surgical excision and suture repair

90
Q

Prepatellar bursitis in wrestler

A

Septic bursitis

91
Q

MPFL origin & insertion

A

Origin: between medial epicondyle & adductor tubercle

insertion: superomedial border of patella

Primary constraint to lateral patellar instability 0-20 eg

92
Q

Function of patella

A

Transmits tensile forces generated by patellar tendon

Increases lever arm of the extensor mechanism

93
Q

Patella joint reaction forces (squatting, descending stairs)

A

Squatting = 7x body weight

Descending stairs = 2-3x body weight

94
Q

Normal Q angle

A

Males = 13

Females = 18

line drawn from the anterior superior iliac spine –> middle of patella –> tibial tuberosity

95
Q

Miserable malalignment syndrome

A

3 anatomic characteristics leading to increased Q angle

  1. femoral anteversion
  2. genu valgum
  3. external tibial torsion
96
Q

Risk factors for patellar instability

A
    • ligamentous laxity
    • previous patellar instability event
    • “miserable malalignment syndrome” — femoral anteversion, genu valgum, external tibial torsion
    • osseous –> patella alta, trochlear dysplasia, excessive patellar tilt, lateral femoral condyle hypoplasia
97
Q

Evaluation of patellar height - Blumensaat’s line

A

Blumensaat’s line should extend to inferior pole of the patella at 30 degrees of knee flexion

98
Q

Evaluation of patellar height - Insall-Salvatti Index

A

Patellar tendon length / Patellar length

Normal = 0.8-1.2

99
Q

Evaluation of patellar height - Caton Dechamps method

A

Tibial plateau - inferior patella face / length of patella face

Normal = 0.6-1.3

100
Q

Lateral patellofemoral angle

A

Normal opens up laterally

Normal > 11

101
Q

TT-TG distance

A

Distance between tibial tubercle and trochlear groove

> 20 mm is abnormal

102
Q

Indication for nonoperative treatment of patellar instability

A
    • first time dislocator

- - habitual dislocator

103
Q

Nonoperative tx patellar instability

A

– NSAIDs, activity modification, PT

PT entails:

    • short term immobilization followed by 6 wks controlled motion
    • closed chain short arc quad exercises
    • quad, core, hip strengthening
    • patellar stabilizing sleeve
104
Q

Indication for MPFL reconstruction

A

Recurrent instability with no significant alalignment

105
Q

Indication for Fulkerson-typeosteotomy

A
  • -may be used in addition to MPFL or in isolation for significant malalignment
    • TT-TG > mm on CT
106
Q

Indication for Fulkerson-type osteotomy in children

A

DO NOT do tibial tubercle osteotomy in skeletally immature child — will injure the physis

107
Q

Risk factors for re-dislocation after patellar dislocation:

A

Age < 20
Nonoperative treatment
– bony (trochlear dysplasia, high Q-angle, high TT-TG)
– soft tissue (weak VMO, patella alta, tight lateral structures)

108
Q

Lateral patellar compression syndrome

A

Improper tracking of the patella in the trochlear groove

– Caused by tight lateral retinaculum —> on PE can’t ever the lateral edge of the patella

109
Q

Treatment of lateral patella compression syndrome

A

Nonop, Nonop, Nonop

–> emphasize vastus medialis strengthening & closed chain short arc quadriceps exercises

110
Q

Indications for lateral release for lateral patella compression syndrome

A
    • evidence of lateral tilting
    • pain rfractory to extensive rehab
    • inability to evert the lateral edge of the patella
    • no instability; limited patellar glide
111
Q

Outerbridge classification of chondromalacia

A 
I    =    softening
II   =    Fissures
III  =    Crabmeat changes
IV  =    Exposed subchondral bone
112
Q

Nonoperative tx patellofemoral syndrome

A

rest, rehab, NSAIDs

PT:

    • vastus medialis strengthening
    • core strengthening
    • closed chain quad exercises
    • strengthening the hip external rotators
113
Q

Demographics of quad tendon rupture

A

> 40 yo man

Most fail at quad tendon inseration on patella

114
Q

Risk factors for quad tendon rupture

A
    • renal failure
    • diabetes
    • rheumatoid arthritis
    • hyperparathyroidism
    • connective tissue disorders
    • steroid use
    • intraarticular injections (in 20-33%)
115
Q

Ideal fixation for quad tendon repair

A

Suture anchors — have been shown to decrease gap formation and increase ultimate loads to failure

116
Q

Demographics of patellar tendon rupture

117
Q

Position of knee with greatest forces on patellar tendon

A

knee flexion > 60 degrees

118
Q

Indications for patellar tendon repair

A
    • complete patellar tendon ruptures

- - ability to approximate tendon at site of disruption

119
Q

Indicatoins for patellar tendon reconstruction

A

– severely disrupted or degenerative patella tendon

120
Q

Most common location of OCD in the knee

A

Posterolateral aspect of the medial femoral condyle

121
Q

Treatment of femoral condyle OCD < 4cm^2

A

Microfracture or OATs

122
Q

Treatment of femoral condyle OCD > 4cm^2

A

Osteochondral allograft transplantatoin OR autologous chrondrocyte implantation

123
Q

Rehab after microfracture for OCD

A

protected weight bearing and continuous passive motion (CPM) are used while mesenchymal stem cells mature into mainly fibrocartilage

124
Q

Goal of OATs

A
    • Goal is to replace a cartilage defect in a high weight bearing area with normal autologous cartilage and bone plug(s) from a lower weight bearing area
    • chondrocytes remain viable, bone graft is incorporated into subchondral bone and overlying cartilage layer heals.
125
Q

Rehab after OATs for OCD

A

NWB x 3 mos bc risk of dislodging graft

126
Q

Limitations of OATS for OCD

A
    • size constraints and donor site morbidity limit usage of this technique
    • matching the size and radius of curvature of cartilage defect is difficult
    • fixation strength of graft initially decreases with initial healing response
      - - weight bearing should be delayed 3 months
127
Q

Limitations of osteochondral allograft transplant for OCD

A
    • limited availability and high cost of donor tissue

- - live allograft tissue carries potential risk of infection

128
Q

Limitations of autologous chondrocyte implantation

A
    • must have full-thickness cartilage margins around the defect
    • open surgery
    • 2-stage procedure
    • prolonged protection necessary to allow for maturation
129
Q

Contraindications for Fulkerson for patellar OCD

A
    • superior medial patellar arthrosis (scope before you perform the surgery)
    • skeletal immaturity
130
Q

In consideration of donor site for OATs — where on the trochlea has the lowest contact pressure?

A

Dital and medial

131
Q

Factors associated with good short term outcomes following microfracture of the knee

A
    • high fill rate on follow-up MRI
    • low BMI
    • short duratoin of preop symptoms
132
Q

Risk factors for osteonecrosis

A
    • alcohol
    • decompression sickness (“the bends”)
    • Gaucher’s
    • sickle cell
    • hypercoagulable state
    • steroids
    • SLE
    • IBD
    • transplant
    • virus (CMV, hepatitis, HIV, rubella)
    • protease inhibitor
    • trauma
133
Q

Treatment of spontaneous osteonecrosis of the knee

A

Thought to be a subchondral insufficiency fracture — thus responds well to nonoperative therapy

– NSAIDs, narcotics, protected weight bearing

134
Q

Prognostic factors in juvenile OCD

A

age

    • younger age = better prognosis
    • open distal femoral physis is best predictor of successful nonop tx

location

    • lateral femoral condyle & patella have worse prognosis
    • < 2cm in diameter

appearance

    • sclerosis on XR = poorer prognosis
    • synovial fluid behind lesion on MRI = poorer prognosis
135
Q

Physical exam maneuver for OCD of the knee

A

Wilson’s test == pain with internally rotating the tibia during extension of the knee between 90° and 30°, then relieving the pain with tibial external rotation

136
Q

Indication for nonoperative tx of juvenile osteochondritis dissecans

A

stable lesion in children with open physes
asymptomatic lesions in adults

50-75% heal without fragmentation

137
Q

Indication for operative tx of juvenile OCD

A
    • impending physeal closure
    • clinical signs of instability
    • expanding lesions on plain XR
    • failed nonop tx
138
Q

Indication for subchondral drilling of OCD

A
    • stable lesion seen on arthroscopy

- - performd either transchondral or retrograde

139
Q

Indicaiton for fixation of unstable OCD

A

– unstable lesion seen on arthroscopy or MRI > 2cm in size

140
Q

Indication for chondral resurfacing of unstable OCD

A

– Large lesions, >2x2cm

141
Q

Indication for operative tx of Osgood Schlatter’s:

A

90% improve with nonop

    • refractory cases (10% of pts)
    • Skeletally mature with persistent sxs –> ossicle excision
142
Q

Sinding-Larsen-Johansson Syndrome

A

Overuse injury causing anterior knee pain at the inferior pole of patella at the proximal patella tendon attachment — similar to Osgood-Schlatter’s disease which is at the distal attachment of the patella tendon

143
Q

Tissue for ACL recon graft with highest maximum load to failure

A

Quadruple semitendinosus & gracilis tendons

144
Q

Function of ACL

A

“Primary: Resists anterolateral displacement of the tibia on the femur

Secondary: Resists varus displacement at 0 degrees of flexion”

145
Q

Function of PCL

A

“Primary: Resists posterior tibial displacement, especially at 90 degrees of flexion

Secondary: Resists varus displacement at 0 degrees of flexion”

146
Q

Function of LCL

A

“Primary: Resists varus displacement at 30 degrees of flexion

Secondary: Resists posterolateral rotatory displacement with flexion that is less than approximately 50 degrees”

147
Q

Funciton of PLC

A

“Primary: Resists posterolateral rotation of the tibia on the femur

Secondary: Resists varus angulation and posterior displacement of the tibia on the femur”

148
Q

Function of MCL

A

Primary: Resists valgus angulation

149
Q

Layers of the lateral knee

A

“Layer I: Iliotibial tract, biceps femoris
Common peroneal nerve lies between layer I and II
Layer 2: Patellar retinaculum
Layer 3: Superficial: LCL, fabellofibular ligament, ALL
Lateral geniculate artery runs between deep and superficial layer
Deep: Arcuate ligament, coronary ligament, popliteus tendon, popliteofibular ligament, capsule”

150
Q

Layers of the medial knee

A

“Layer I: Sartorius and fascia (patellar retinaculum)
gracilis, semitendinosis, and saphenous nerve run between layer 1 and 2
Layer 2: Semimembranosus, superficial MCL, MPFL, posterior oblique ligament
Layer 3: Deep MCL, capsule, coronary ligament”

151
Q

Anteromedial bundle of the ACL function

A

“fibers are parallel in extension
fibers are externally rotated in flexion
tight in both flexion and extension”

152
Q

Posterolateral bundle of the ACL function

A

“PL bundle prevents pivot shift
prevents internal tibial rotation with knee near extension
tight in extension, loose in flexion”

153
Q

Blood supply to ACL

A

middle geniculae artery

154
Q

Tensile strength of native ACL vs BPTB vs quadrupled hamstring:

A

native ACL 2200 N
BPTB 3000N
quadrupled hamstring 4000N

155
Q

Anterolateral bundle of PCL

A

Tight in flexion

Mnemonic — ““PAL”” – PCL has an AnteroLateral bundle

156
Q

Posteromedial bundler of PCL

A

Tight in extension

157
Q

Ligament of Humphrey

A

Meniscofemoral ligament originating from posterior horn of the lateral meniscus and attaches to lateral surface of MFC just ANTERIOR to the PCL

158
Q

Ligament of Wrisberg

A

Meniscofemoral ligament originating from posterior horn of the lateral meniscus and attaches to lateral surface of MFC just POSTERIOR to the PCL

159
Q

Origin and insertion of superficial MCL

A

“Origin: pedial femoral epicondyle
Insertion: periosteum of proximal tibial just deep to pes anserinus

Runs just deep to gracilis and semitendinosus”

160
Q

Function of MPFL

A

Restraint against lateral translation of the patella at 0 to 30 degrees of knee flexion

161
Q

Avulsion fx of ALL insertion

A

ACL rupture

This is a Segond fx

75% associated with ACL

162
Q

Order of neurovascular structures in the posterior knee running from superficial to deep

A

Superficial to deep && lateral to medial

Tibial nerve -> popliteal vein ->, popliteal artery

PC Sports (5 decks)

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