SPORTS Flashcards
Tx ACL + medial compartment OA
HTO, medial opening wedge w decr tibial slope
Loss of what motion with FAI
decr flexion, IR
Tension sided femoral neck fx tx (superolateral femoral neck)
CRPP
what is assoc with lateral meniscal cysts
middle 1/3 lateral meniscus tears
crossover sign means
FAI, pincer lesion
excess acetabular retroversion
FAI return to sports in
7 months
Vertical ACL graft causes what effect
failure to reconstruct posterolateral bundle
instability with cutting activity
exam assoc with stinger
positie Spurling sign
resolves in 1-2 min
athletic pubalgia is overuse assoc with what movmeent
hip extension ABDuction
bone bruise location for ACL
posterolateral tibia
lateral femoral condyle
excess anterior femoral tunnel placement causes
loss of knee flexion
graft overstretch, failure
interference screw divergence
tx quad contusin
immobilization in knee hyperflexion
positive DIAL at 30 deg means vs at 30+90 deg
at 30 ONLY = PLC
at 30 + 90 = PLC + PCL
what defines anterior edge of ACL
what separates AM and PL bundles
anterior edge ACL = lateral intercondylar ridge = resident’s ridge
separates AM/PL bundle = bifurcate ridge
PCL
AL bundle tight in __
PM bundle tight in __
AL tight in flexion
PM tight in extension
angle used to determine if lateral retinacular release useful
lateral patellofemoral angle
tx for bucket handle tears
inside-out vertical mattress sutures
LCL relative to lateral femoral epicondyle
proximal
posterior
type 1 muscle fibers
type
recruit order
slow oxidative
recruit first
type 2 muscle fibers
fast glycolytic
initial exercise for PCL tear
quad (not hamstring strengthening) and ROM in prone to limit posterior sag
risk factor for poor arthro hip surgery
acetab subchondral cyst (hip OA), Tonnis grade 2
deep interval for inside-out meniscal repair
btwn medial head of gastroc and joint capsule
nerve at risk with inside-out meniscal repair
saphenous nerve
ACL fibers
AM bundle tight in ___
PL bundle tight in __
AM tight in flexion
PL tight in extension
PCL deficient knee incr risk of early OA where
medial
patellofemoral compartments
Cytotoxin that defines CA-MRSA
PVL
suture anchor vs transosseous suture repair for quad rupture
higherload to failure?
less gap formation?
suture anchor repair better
over the top position for ACL graft results in
lax flexion
tight extension
b/c femoral portion of graft more posterior than anatomic origin of ACL
if ACL graft too anterior
tight in flexion
loose in extension
MPFL primary restraint
first 30 deg knee flexion
where is osteochodral fx typically in lateral patellar dx
medial patella
FAI
head neck ratio
femoral offset
ante or retroversion
decr head neck ratio
decr fem offset
retroversion
saphenous n injury most common w which medial meniscus repair
inside-out
anteromedial portal for femoral tunnel better than transtibial portal b/c
more anatomic graft placement but shorter fem tunnel, incr risk to lateral fem cartilage
(transtibial = more vertical)
elevated sulcus angle assoc w what
> 140 deg = flattening of trochlea
risk factor for failure of MPFL recon
trochlear dysplasia
incr TT TG
decr age less than 20
factors assoc w OA in ACL deficient knee
meniscal lesion
osteochondral lesion
malalignment
concomitant lig path
highest risk of persistent patellar instability
previous patellar instability event
Q angle measures
ASIS to patella and patella to tibial tubercle
mc problem w tunnel malposition
too anterior in front of lateral intercondylar ridge – graft impingement and failure
mechanism of pivot
extension - lateral tib plateau sublux
w IR/valgus, lateral tib plateau reduces
tx compression (inferior) sided fem neck fx
protected weightbearing
fxn of popliteus
internal tibial torsion
wear assoc w chronic PCL occurs
patellofem and medial compartment
Ways to decr graft-screw divergence (should be less than 30 deg)
1) insert screw/drill from same portal
2) hyp`erflex knee when insert screw
3) use guide wire to help gauge mismatch
predisposing factors to patellar instability
xs femoral IR, tibial ER, LFC hypoplasia, insufficiency of VMO, incr Q angle, tight lateral retinaculum, patella alta, patella tilt
with ACL injury, what are knee kinematics
absence of normal femoral IR during terminal swing phase & decr anterior translation of tibia in late swing
nl knee movement
1) during heel strike
2) during midstance
1) IR of femur relative to tibia
2) flexion of knee, ER of femur relative to tibia
PL bundle of ACL resists rotation in knee flexion or extension
knee extension
factros assoc w failure of HS autograft for ACL
graft size less than 8 mm
age less than 20 yrs
valgus producing HTO addresses PCL and PLC injury by
incr tibial slope
shift tibia anterior to femur
stinger mc affects
biceps deltoid rotator cuff muscles
bursal vs articular sided tears
which higher risk of progression
bursal
bursal vs articular sided tears
bursal usu due to
extrinsic causes - AC arthritis, acromial cysts
bursal vs articular sided tears
articular usu due
intrinsic causes - degenerate weakening of tendon
bursal vs articular sided tears
bursal sided tendon repair when
more than 25% tendon depth
bursal vs articular sided tears
articular sided tendon repair when
more than 50% tendon depth
bennett lesion = posterior-inferior glenoid mineralization seen in what population
baseball players
Posteromedial elbow pain worse on ball release/decel + TTP over PM olecranon
valgus extension overload
tx = flexor-pronator strengthening
rTSA moves COR in what direction
medial which incr moment arm of deltoid
mUCL at greatest stress during what phase of throwing
late cocking/early accel
in posterior capsular contracture of shoulder, humerus translates in what direction during cocking phase
posterior superior
scapular notching occurs due to
superior placement of glenoid component
POSITIVE pivot shift after ACL recon
failure to reconstruct PL bundle of ACL with femoral tunnel [vertical tunnel at 12:00]
incr AP instability after ACL recon
failure to reconstruct AM bundle of ACL
tib tunnel too anterior causes
knee tight in flexion w impingement
tib tunnel too posterior
knee instability w +Lachman/pivot shift
risk factors for re-rupture
female
small fem notch
small lig girth
incr Q angle
ACL tear assoc w lateral or medial meniscus
lateral
fem tunnel position in R vs L knee
right = 1030 left = 130
mc tunnel error
tibial or fem tunnel too anterior causing graft impingement
if graft too anterior causes
decr flexion
if graft too posterior
decr extension
tendon w highest load to failure
quadruple hamstring
during pivot shift IT band does what
reduction of lateral tib plateau w flexion
how to avoid graft screw divergene
put screw/drill in same portal, hyper flexing knee when insert screw , use guidewire to gauge mismatch
which bundle of ACL loose flexion
PL bundle
landmark for accurate tibial tunel placement
11 mm anterior to anterior border of PCL
what marks anterior extent of ACL fem insertion
lateral intercondylar ridge = resident ridge
what separates AM and PL bundle
bifurcate ridge
secondary restraint to anterior tibial translation
posterior horn MM
saphenous n injury during medial meniscus repair MC with which technique
inside out repair
which has more mobility
medial or lateral meniscus
lateral b/c less attachments
best way to tx bucket handle meniscus tear
inside out vertical mattress
mc long term complication after meniscal transplant
meniscal graft tear 2/2 acellularity of graft tissue
good prognostic factors for meniscal repair
vertical longitudinal tears
red-red
small rim width
how to reduce axillary n risk during anterior labral repair
put arm in abduction, ER
