Sport Flashcards
Arcuate sign
Avulsion of LCL (head of fibular), fracture will be horizontal
*Segond fracture is vertical and undisplaced
ALL attachment
Lateral femoral condyle to the midpoint of Gerdy tubercle and fibular head
Botch box bump
Healed Segond fracture
Bone bruises in ACL
Middle third of femur condyle and posterior tibia plateau
> Cause prolonged clinical recovery
> Slower return to function
> High-risk OA
> Effusion
AM/PL bundles
In knee extension AM in front, flexion >90 AM cross and behind PL
ACL is not isometric
(different during fix point, flex and extend, roll back)
Reconstruction is isometric to prevent failure
Saphenous nerve injury
Medial to lateral
- Anterolateral aspect of tibia numbness if injure during hamstring graft harvest
The diameter of graft
At least 8mm
<7.5 =14%
Allograft advantages
- Superior cosmesis,
- Large quantity (suitable for multi-ligaments),
- Shorter operative time
Allograft disadvantages
5D
>Dollar (expensive)
>Disease transmission
>Delay immunogenic reaction
>Disturb mechanical properties
>Delay incorporation
Bone patella tendon bone
Taken from the medial third
The first reason for ACL reconstruction failure
Tunnel misplacement
Bracing in ACL
Does not offer long-term benefit
Acceptable ROM before operation
0-120 (AAOS)
ALL reconstruction
For revision ACL, high-demand athlete
Pivot shift test
- Sliding motion at 30-45 degrees due to iliotibial band (relocation of the tibia)
- Grade IKDC :
1 Gliding
2 Clunking
3 Lock subluxation
Meniscus tear type
Bucket handle, vertical, longitudinal, radial
Meniscus Repairable vs Irreparable
> Repairable: Bucket handle, longitudinal, root
Irrepairable: Radial, complex, degenerative
Meniscus blood supply
- Perimeniscal capillary plexus > middle geniculate, inferior geniculate, and inferolateral geniculate
Meniscus tear size
- 1cm is a stable tear
- 4cm is a high failure rate
Meniscus repair
- No total meniscectomy because of the high risk of OA
- Root tear is irreparable because it is important to dissipate the load and convert to hook stress
- Repair with transtibial reconstruction or anchor suture
Meniscus repair technique
- Inside out (Gold standard) = Versatile, Learning curve not steep, Direct visualization
- All inside
- Outside in
Approach to locked knee
- Gentle manipulation/rotation
- If can reduce, put the backslab in 30 degrees flexion, do mri within 1 week, then schedule a scope within 1 week.
- If can’t reduce, put the backslab in current position, urgent mri, scope next day
