Sports Flashcards
What is the blood supply of the ACL?
Middle geniculate artery
What is the innervation of the ACL?
posterior articular nerve
What is a Segond fracture?
Avulsion off proximal lateral tibia; pathognomonic for ACL tear; represents bony avulsion by the ALL (anterolateral ligament)
What is the bone bruising pattern seen on MRI in an ACL rupture?
middle 1/3 of LFC (sulcus terminalis) posterior 1/3 of lateral tibial plateau
What is the empty notch sign seen on MRI?
Fluid next to lateral wall of LFC; indicative of ACL rupture
Name these structures
middle genicular artery supplies ACL
Which bundle of the ACL is primarily responsible for rotational stability?
posterolateral bundle of the anterior cruciate ligament (ACL) is primarily responsible for rotational stability of the knee
What is the origin of the LCL?
posterior (3.1 mm) and proximal (1.4 mm) to lateral epicondyle; posterior and proximal to origin of popliteus; popliteus origin is 18.5 mm from LCL origin
What is the relationship of the origin of the LCL and the origin of the popliteus?
posterior and proximal to origin of popliteus; popliteus origin is 18.5 mm from LCL origin
What is the most anterior structure on the proximal fibula?
The LCL
What is the posterior wall sign on an AP hip XR?
Posterior rim of acetabulum is medial to center of femoral head (seen in acetabular retroversion)
What is a normal hip α angle?
less than 42 deg; greater than 50 deg indicates Cam lesion
What is a normal head-neck offset ratio?
0.17; <0.17 indicates cam deformity
What is a normal lateral center edge angle and a anterior center edge angle?
less than 40 deg and greater than 20 deg
What is the Ganz open hip surgical dislocation?
Kocher approach - split the glute max then perform a digastric greater trochanter osteotomy, capsulotomy is performed, dislocate anteriorly.
What is the origin of the LCL in relation to the popliteus origin?
Posterior and superior to popliteus
What is the mechanism of injury when a patient sustains a Segond fracture?
internal rotation and varus load (compared to most ACL injuries which are valgus stress)
What are the two bundles of the ACL?
Anteromedial and Posterolateral
Which bundle of the ACL is examined by the pivot shift test?
Posterolateral bundle
On the femur, what is the orientation of the ACL bundles?
Anteromedial originates more proximally than the posterolateral bundle
Which ACL bundle is the primary restraint to anterior tibial translation?
Anteromedial
Who is the optimal candidate for a latissimus dorsi transfer?
young laborer with massive posterosuperior rotator cuff tear with atrophy and signific
The primary function of the ACL is to resist […] translation of the tibia on the femur
anterolateral
The secondary function of the ACL is to resist […] at […] degrees of flexion.
varus; 0
The primary function of the PCL is to resist[…]tibial displacement, especially at […] degrees of flexion
posterior; 90
The primary function of the LCL is to resist […]displacement at […] degrees of flexion
varus; 30
The primary function of the […] is to resistposterolateralrotation of the tibia on the femur
PLC/popliteofibular ligament
In the ACL, the posterolateral bundle originates […] to anteromedial bundle (on femur).
posterior and distal
On the tibia, the ACL inserts […] and […] the intercondylar eminences of the tibia
anterior; between
What is the average anatomical size fo the ACL?
33 mm x 11 mm
What is the innervation of the ACL?
posterior articular branches of tibial nerve
What is the function of the innervation of the ACL?
Proprioception and modulation of quadriceps function
The ACL is composed of 90% of type […] collagen and 10% of type […] collagen.
Type I; Type II
What is the native tensile strength of the ACL?
2200N
The PCL is made of which two bundles?
Anterolateral, posteromedial
When performing a double-bundle PCL repair, the anterolateral bundle should be tensioned in […]
mid-flexion
When performing a double-bundle PCL repair, the posteromedial bundle should be tensioned in […]
extension and high flexion
Tightening the posteromedial bundle of the PCL in extension protects against […]
hyperextension
What anatomic structure on the tibia separates the anterolateral bundle from the posteromedial bundle?
medial bifurcate ridge
What are the variable meniscofemoral ligaments that originate from the posterior horn of the lateral meniscus and insert into the substance of the PCL?
Ligament of Humphrey (anterior to PCL); Ligament of Wrisberg (posterior to PCL)
The ligaments of Humphrey and Wrisberg originate from the posterior horn of the […] meniscus
lateral
What is the blood supply to the PCL?
Middle geniculate artery
The LCL is tight in […] and lax in […]
extension; flexion
What are the anatomic structures of the the posterolateral corner?
LCL; popliteus; popliteofibular ligament; lateral capsule
The PLC works synergistically with the PCL to control […] and […] translation
external rotation; posterior
The[…] MCL is the primary stabilizer to valgus stress at all angles
superficial
The deep MCL attaches to medial meniscus via the […]
coronary ligament
The […] MCL and posteromedial capsule act as secondary restraints to valgus stress at full knee extension
deep
What are the anatomic structures of the posteromedial corner of the knee?
semimembranosus, posterior oblique ligament, oblique popliteal ligament, posterior capsule
The posterior oblique ligament resists […] load and tibial internal rotation in […]
valgus; full extension
The […] resists valgus load and tibial internal rotation in full extension
posterior oblique ligament
The MPFL provides restraint against lateral translation of the patella from […] degrees of knee flexion
0 to 30
The MPFL femoral attachment is […] to adductor tubercle and […] to MCL attachment
distal; proximal
The risk of 2nd patella dislocation is […] percent; and risk of 3rd dislocation (after 2nd dislocation) is […] percent
13; 50
What is the tibial attachment of the anterolateral ligament (ALL).
midway between Gerdy’s tubercle and head of fibula
What vascular structure is contained between lateral meniscus and ALL at the level of the knee joint line?
lateral inferior geniculate artery and vein
What is the origin of the MCL of the knee?
originates slightly posterior and proximal to the medial epicondyle
What is the arcuate sign on a knee XR?
avulsion fracture of the proximal fibula at the site of insertion of the arcuate ligament complex
The arcuate sign on a knee XR is associated with what injury?
Cruciate ligament injury 90% of cases
In an arcuate ligament avulsion fracture, the fragment is attached to the […] or […] tendon
LCL; biceps femoris
Degenerative meniscal tears in older patients usually occur in the […] meniscus
posterior horn medial
Are medial or lateral meniscal tears more common in acute ACL injuries?
Lateral
Complete […] meniscal tears that extend to the meniscocapsular junction are biomechanically equivalent to posterior root tears
radial
What is the most sensitive physical exam finding in meniscal tears?
Joint line tenderness
What is the pathophysiology of a discoid meniscus?
Failure of apoptosis in utero
The most common long-term complication after meniscal transplantation is […]
meniscal graft tear due to acellularity
A double anterior horn sign on knee MRI is indicative of what injury?
flipped lateral meniscus tear
Saucerization of a discoid meniscus to a […] mm peripheral rim is recommended
6-8
What is the most common variant of a discoid meniscus?
complete
What coronal plane deformity increases the risk for ACL re-rupture?
Varus
What is the treatment for concomitant low grade MCL injury in an ACL rupture?
Allow MCL to heal prior to ACLR
There is […] meniscal healing rate when repaired at the same time as ACL
increased
Failure to recognize and address PCL/PLC injuries will lead to […] instability and ACL graft overload
varus
The tibial tunnel for ACLR should be […] in front of the anterior border of PCL.
10-11 mm
The tibial tunnel for ACLR should be […] anterior to the median eminence
6mm
The tibial tunnel for ACLR should be […] posterior to the inter-meniscal ligament
9 mm
Fixation of an ACL graft should be performed in […] degrees of flexion
20-30
Which ACL graft choice has the highest incidence of anterior knee pain?
BPTB
What is the most important factor found to increase physeal injury in ACLR?
Tunnel diamter > 12 mm
What is the most common cause of ACL reconstruction failure?
graft failure due to tunnel malposition
Placement of the femoral tunnel too anterior in ACL reconstruction leads to a knee that is tight in […] and loose in […]
flexion; extension
Plaement of the femoral tunnel too posterior in ACL reconstruction leads to a knee that is tight in […] and loose in […]
extension; flexion
Graft-screw divergence greater than […] degrees in ACL reconstruction can lead to implant failure
30
An ACL graft needs to be at least […] mm
8
Posterior tibial slope greater than […] degrees is a preoperative risk factor for ACL reconstruction failure.
12
Which nerve can be injured in hamstring autograft harvesting?
Saphenous
The middle geniculate artery arises directly from the popliteal artery and pierces the […] ligament prior to supplying the ACL and PCL.
oblique popliteal
Isolated PCL injuries cause the greatest instability at […] degrees of flexion
90
The ligament of Humphrey (anterior) and ligament of Wrisberg (posterior) originate from the posterior horn of the […] meniscus and insert into PCL substance.
lateral
What is the blood supply to the PCL?
Middle geniculate artery and fat pad
A dial test with greater than 10 deg ER asymmetry at 30 deg and 90 deg is consistent with […] injury
PLC and PCL
A dial test with greater than 10 deg ER asymmetry at 30 deg only is consistent with […] injury
isolated PLC
[…] and […] compartment arthrosis may be present with chronic PCL injuries
Medial; patellofemoral
When fixing a PCL arthroscopically, what accessory portal is utilized?
accessory posteromedial
The knee accessory posteromedial portal is placed […] mm proximal to the joint line posterior to the MCL
10
What nerve can be injured with use of a knee accessory posteromedial portal?
saphenous
PCL graft fixation is fixed with the knee flexed to […] degrees
90
Open approach to PCL fixation is beneficial in that there is less […]
graft attenuation and failure
Which bundle is constructed in a single-bundle PCL reconstruction technique?
anterolateral
When performing a PCL double bundle reconstruction, which bundle is tensioned in extension?
posteromedial
When performing a double bundle PCL reconstruction, which bundle is tensioned in 90 deg flexion?
anterolateral
PCL rehabilitation is focused on […] muscle strengthening
quadriceps
Chronic PCL deficiency leads to increased contact pressures in the […] and […] compartments
patellofemoral; medial
Which cruciate ligament injury is more common in PLC injuries?
PCL
What is the origin of the popliteofibular ligament?
musculotendinous junction of the popliteus
What is the insertion of the biceps femoris?
primarily on fibular head (also LCL and lateral tibia)
The popliteus works to control […] tibial rotation
external
Greater than […] mm difference in varus stress radiographs of the AP knee indicated a PLC injury
4
In acute PLC injury, what bony bruising is seen on MRI?
Medial femoral condyle and medial tibial plateau
Anatomic reconstruction of the PLC restores […] stability, but not all […] stability on stress testing
rotatory; varus
PLC reconstructions have […] revision rates and […] outcome scores than ligament repair
less; better
In patella dislocations, osteochondral fractures occur most often as the patella […]
relocates
What is the primary restraint of the patella in the first 20-30 degrees of flexion?
MPFL
What is the origin of the MPFL?
Between the adductor tubercle and medial epicondyle
Is the origin or insertion usually the site of MPFL avulsion?
origin
Is a J-sign is associated with patella baja or alta?
alta
A normal lateral patellofemoral angle is greater than […] degrees
11
On a merchant/sunrise view, a normal lateral patellofemoral angle is one that opens […]
laterally
A sulcus angle greater than […] degrees indicate flattening of the trochlea concerning for dysplasia
140
A TT-TG greater than […] mm is usually considered abnormal
20
What is the most important predictor of residual patellofemoral instability after isolated MPFL reconstruction?
trochlear dysplasia
When performing an anteromedializing tibial tubercle osteotomy, goal is TT-TG correction to […] mm
10-20
Recurrent patealla dislocation rate is highest in those who sustain a primary dislocation under the age of […]
20
A flexion contracture greater than […] degrees is a contraindication to performing a HTO for ACL deficiency.
15
A BMI greater than […] is a contraindication to performing an HTO in ACL deficiency.
35
When repairing a patellar tendon, which technique has been shown to decrease the rate of re-rupture and has higher ultimate load to failure?
suture anchor tendon repair
In post op rehabilitation for patellar tendon repair, when does early range of motion begin?
at 7-10 days
What is the most common complication following patellar tendon rupture?
knee stiffness
What is the most important prognostic factor in complete patellar tendon ruptures?
timing of repair
In a chronic ACL tear, the common pattern of chondral wear is anterior aspect of the […] femoral chondyle and […] tibial plateau
lateral; posterolateral
Osteochondral defects greater than […] cm2 on the femoral condyle is an indication for osteochondral allograft transplantation or autologous chondrocyte implantation
4
Marrow stimulation techniques for osteochondral defects relies of formation of type […] > type […] cartilage
type 1 > type 2 cartilage
MACI results in results in Type […] and Type […] collagen
I and II
The anterolateral bundle of the PCL is tight in […], while the posteromedial bundle is tight in […].
flexion; extension
The […] bundle of the PCL is tight in flexion, while the […] bundle is tight in extension.
anterolateral; posteromedial
Untreated PCL deficiency most commonly results in increased degenerative changes to the […] and […] compartments.
medial; patellofemoral
There is increased […] alignment with PCL deficient knees
varus
The most common location for osteochondritis dissecans of the knee is the […] femoral condyle (70% of lesions in knee).
posterolateral aspect of medial
Subchondral drilling of a stable osteochondritis dissecans lesions leads to formation of […] tissue
fibrocartilagineous
In osteochondritis dissecans of the knee, […] are the best predictor of successful non-operative management
open distal femoral physes
Following osteochondral autograft transfer (OATs), biopsy will show primarily type […] collagen at one year.
type II collagen (note, chondrocytes remain viable!)
Subchondral drilling of an osteochondral defect will create […] tissue.
fibrocartilage
Which muscles originate from the ASIS?
Sartorius and TFL
ASIS avulsion fracture is due to forceful contraction of which muscle(s)
Sartorius/TFL
CAM lesions are usually found on the […] aspect of the femoral neck
anterolateral
Pincer lesions are usually found on the […] aspect of the acetabular rim
anterosuperior
Pincer lesions lever the femoral head into the […] aspect of the acetabulum leading to a contrecoup cartilaginous injury
posteroinferior
A hip α angle greater than […] deg indicates Cam lesion
50
When performing a femoral-head neck osteoplasty for a CAM lesion, the osteoplasty should be less than […] percent of the femoral neck diameter to decrease the risk of FNF.
30
The anterolateral hip portal is located […] to anterosuperior border of greater trochanter
2 cm anterior and 2 cm superior
Which structure is at risk with the placement of the anterolateral hip arthroscopy portal?
Superior gluteal nerve
What sensory nerve is at risk with placement of the anterior portal in hip arthroscopy?
LFCN
The LFCN is at risk with placement of which hip arthroscopy portal?
Anterior portal
What vascular structure is at risk with placement of the anterior hip arthroscopy portal?
ascending branches of lateral femoral circumflex artery
The ascending branches of lateral femoral circumflex artery are at risk during placement of which hip arthroscopy portal?
Anterior portal and DALA
What structure is at risk with placement of the DALA hip portal?
ascending branches of lateral femoral circumflex artery
What hip arthroscopy structure is the landmark for the iliopsoas tendon?
Zona orbicularis
In hip arthroscopy, the zona orbicularis is the landmark for the […] tendon
iliopsoas
What is the most common overall neurovascular complication seen in hip arthroscopy?
pudendal nerve injury
In ischiofemoral impingement, MRI often exhibits signal intensity in the […] tendon
quadratus femoris
What is the most common reason for failed hip arthroscopy for FAI?
residual impingement
What is the most common complication following hip arthroscopy?
iatrogenic chondral injury
In FAI, which occurs first, cartilage delamination or labral tearing?
cartilage delamination; remember: Cam lesions can lead to cartilage delamination at the chondrolabral junction that precedes labral tearing in the anterosuperior quadrant.
Are you more likely to see counter-coup cartilage damage in a Pincer or CAM lesion?
Pincer
Females land with their knees in more […] and […] due to hip internal rotation
extension; valgus
What is the most common cause of amenorrhea in female athletes?
insufficient caloric intake
Obtain a […] in female athletes with a history of amenorrhea and stress fractures
DEXA scan
What hormone in women increases ligamentous laxity?
estradiol
An abnormally low […] lipoprotein level should alert the physician to the possibility of steroid use in an athlete
high-density (ie low HDL)
Carpal tunnel syndrome can be seen in use of which steroid?
Human growth factor
Increased insulin resistance can be seen with the use of which steroid?
Human growth factor
Glucagon has a […] effect on skeletal muscle
catabolic
What is the leading cause of sport related death?
TBI
What is a sideline concussion assessment tool that tests attention and memory?
SCAT5
There is an […]-times higher risk of femoral neck stress fracture propagation if effusion is seen on MRI
8
Cannulated screw fixation is indicated in femoral neck compression-sided stress fractures with fatigue line greater than […] percent femoral neck width
50
[…] stimulates differentiation and proliferation of myofibroblasts
TGF-beta
In Mono, most splenic rupture occurs in first […] weeks
3
