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Orthopaedic Board Study > Sports > Flashcards

Sports Flashcards

1
Q

Associated ACL injury?

A

Lateral meniscus tear 50%

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2
Q

Reasons why women > men for ACL tear?

A
  • neuromuscular forces and control (more quadriceps dominant)
  • landing biomechanics (conditioning and strength) play biggest role, females land in more extension, higher vaglus moment
  • smaller notches
  • smaller ligaments
  • hormone levels
  • valgus leg alignment
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3
Q

ACL function?

A
  • 85% of the stability to prevent anterior translation of the tibia relative to the femur
  • acts as secondary restraint to tibial rotation and varus/valgus rotation
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4
Q

ACL anatomy?

A
  • 33mm x 11mm in size
  • anteromedial bundle
    more isometric
    tight in flexion
  • posterolateral bundle
    tight in extension (contributes greatest to rotational stability)
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5
Q

ACL blood supply?

A

middle geniculate artery

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6
Q

ACL nerve supply?

A

posterior articular nerve (branch of tibial nerve)

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7
Q

ACL composition?

A
  • 90% Type I collagen

- 10% Type III collagen

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8
Q

ACL strength?

A

2200 N

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9
Q

ACL tear grading?

A
  • A= firm endpoint
  • B= no endpoint
  • Grade 1: < 5 mm translation
  • Grade 2 A/B: 5-10mm translation
  • Grade 3 A/B: > 10mm translation
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10
Q

Pivot Shift test?

A

ACL integrity

  • Extension to flexion with internal rotation and valgus
  • Reduces at 20-30 degrees of flexion
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11
Q

KT-1000?

A

For ACL anterior laxity

  • knee in slight flexion
  • ext rotation 10-30 deg
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12
Q

Segond fracture?

A

Pathognomonic for ACL tear

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13
Q

MRI bruising for ACL tear?

A
  • Middle 1/3 lateral femoral condyle

- Posterior 1/3 lateral tibial plateau

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14
Q

Non-op tx of ACL tear?

A
  • low demand patients with decresed laxity
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15
Q

Who gets operative tx for ACL tear?

A
  • young active pts
  • older active pts
  • children
  • previous ACL reconstruction pts
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16
Q

What if ACL tear with MCL injury?

A
  • allow MCL to heal first (varus/valgus instability can put reconstruction at risk)
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17
Q

What if meniscal tear with ACL tear?

A
  • repair meniscus at time of ACL recon

- shows increased healing rates if repaired at same time

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18
Q

What if PLC tear with ACL tear?

A
  • repair at same time

- or repair PLC as first of two stages

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19
Q

Femoral tunnel placement in ACL recon?

A
  • 1-2 mm of bone posterior to tunnel
  • too anterior = tight in flexion, loose in extension
  • too posterior loose in flexion, tight in extension
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20
Q

Tibial tunnel placement in ACL recon?

A
  • 10-11 mm in front of anterior edge of PCL
  • <75 deg from horizontal
  • too anterior = tight in flexion and extension impingement
  • too posterior = ACL impinge on PCL
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21
Q

ACL graft preconditioning?

A
  • reduces stress relaxation up to 50%
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22
Q

ACL graft tensioning?

A
  • no difference in level I study
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23
Q

Limb malalignment in ACL repair?

A
  • high tibial osteotomy to address coronal and saggital plane defects prior to recon
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24
Q

B-P-B ACL graft?

A
  • gold standard
  • 2600 N load to failure
  • higher incidence of knee pain (10-30%)
  • cons = patella fx and patella tendon rupture
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25
Q

Hamstring autograft for ACL tear?

A
  • quadrupal strand
  • 4000 N load to failure
  • decreased fixation strength
  • decreased flexion strength at 3yrs compared to BPB
  • harvest can damage inferior saphenous nerve
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26
Q

Allograft for ACL tears?

A
  • longer incorporation time
  • HIV risk < 1/1 million
  • radiation 3 Mrads to kill HIV
  • freezing kills cell, doesn’t harm graft
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27
Q

Revision ACL reconstruction?

A
  • don’t reharvest BPB
  • use dual fixation
  • conservative rehab
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28
Q

Rehab in ACL tear?

A
  • immediate ice and weight bearing
  • early full passive extension
  • isometric hamstring/quad exercises
  • active knee flexion 35-90 deg
  • closed chain exercises
  • avoid isokinetic quad strengthening and open chain
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29
Q

ACL injury prevention in females?

A
  • neuromuscular training/plyometrics
  • when landing, less valgus and more flexion
  • increase hamstring strength over quads
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30
Q

ACL bracing?

A

Only proven effective in skiers

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31
Q

Most common cause of ACL recon failure?

A
  • poor tunnel placement
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32
Q

ACL femoral tunnel too vertical?

A
  • poor rotational stability and + pivot shift
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33
Q

ACL graft screw divergence > 30 deg?

A
  • can cause inadequate fixation/failure
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34
Q

Cyclops lesion in ACL recon?

A
  • fibroproliferative tissue blocks extension

- “click” heard at terminal extension

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35
Q

ACL recon infxn?

A
  • pain/swelling/erythema/elevated WBC 2-24 days postop
  • immediate I&D
  • serial I&Ds and 6 wks abx to try to retain graft
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36
Q

Facts about exertional compartment syndrome?

A
  • anterior compartment 70%
  • ant/lat compartments 10%
  • males>females
  • 3rd decade
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37
Q

Presentation of exertional compartment syndrome?

A
  • aching/burning pain with exercise
  • begins w/i 10 min, resolves 30-40 min
  • numbness over dorsum of foot
  • relieved by rest
38
Q

Radiographic studies in exertional compartment syndrome?

A

Can only r/o other pathologies.

39
Q

Diagnosing exertional compartment syndrome?

A
  • Compartment pressure measurement
  • three pressure should be measured
    - resting pressure
    - immediate post-exercise pressure
    - continuous post-exercise pressure for 30 min
40
Q

Diagnostic criteria for exertional compartment syndrome?

A
  • resting pressure > 15 mmHg
  • immediate post-exercise is > 30 mmHg and/or continuous post-exercise failed to return to normal or remains > 15 mmHg at 15 minutes after cessation of exercise
41
Q

Treatment of exertional compartment syndrome?

A
  • non-op rarely successful
  • operative
    • anterior incision for ant/lat compartments
    • medial incision if needed for post compartments
    • not always a home run
42
Q

High tibial osteotomy?

A
  • primarily for varus deformity
    • 87% success/10yrs
  • can be for valgus deformity
    • 50-60% success/10yrs
43
Q

Indications for high tibial osteotomy?

A
  • young and active
  • BMI <35
  • good vascular status
  • only one knee affected
  • best results overcorrect 8-10 deg
44
Q

Contraindications for high tibial osteotomy?

A
  • obese
  • inflammatory arthritis
  • flex contracture >15 deg
  • < 90 deg flexion
  • > 20 deg correction needed
  • PF arthritis
  • unstable knee
  • varus thrust gait
45
Q

Contraindications for varus tibial osteotomy?

A
  • > 12 deg correction needed
  • medial compartment arthritis
  • loss of medial meniscus
  • hypoplastic lateral femoral condyle
    • perform femoral osteotomy instead
46
Q

Contraindications for valgus tibial osteotomy?

A
  • narrow lateral joint space
  • loss of lateral meniscus
  • lateral tibial subluxation >1cm
  • medial compartment bone loss >2-3mm
  • varus deformity >10 degrees
47
Q

Advantage of tibial medial opening wedge osteotomy?

A
  • maintains posterior slope
48
Q

Complications of closing wedge lateral tibial osteotomy?

A
  • 60% failure rate after 3 years when
    • failure to overcorrect
    • patients are overweight
  • loss of posterior slope
  • patella baja
  • compartment syndrome
  • peroneal nerve palsy (more common in lateral opening wedge osteotomy)
  • malunion or nonunion
49
Q

Most common hamstring tear/injury?

A
  • occurs at myotendinous jxn
  • avulsion ischial tuberosity less common
    • skeletally immature
    • water skiers
50
Q

Mechanism of hamstring injury?

A
  • hip flexion and knee extension
51
Q

Hamstring muscle components?

A
  • semimembranous
  • semitendinosus
  • biceps femoris
    long head topic
    short head topic
52
Q

Common characteristics of hamstring muscles?

A
  • originate on ischial tuberosity
  • innervated by sciatic (tibial) nerve
  • blood supply from inferior gluteal artery and profunda femoral artery
  • cross and act upon 2 joints: the hip and knee (except short head of biceps femoris)
53
Q

Physical exam findings for hamstring tear?

A
  • ecchymosis in posterior thigh
  • palpable mass in middle 1/3 of posterior thigh (myotendinous rupture)
  • normal hamstring/quadricep ration is 65%
54
Q

Treatment of hamstring tear?

A 
Myotendinous jxn tear
  - non-op
  - protected WB 4 weeks
  - return to play when size 90% of controlateral thigh
Ischial avulsion
  - ORIF
  - incision at gluteal crease
  - protect sciatic nerve
  - suture anchors
55
Q

What is scapular plane?

A
  • 30 deg anterior to coronal plane
56
Q

Ratio of shoulder abduction?

A
  • 2:1
  • GH joint 120 deg
  • scapularthoracic joint 60 deg
57
Q

Affect of internal rotation contracture on shoulder abduction?

A
  • cannot abduct > 120 deg

- > 120 deg requires external rotation to avoid GT impingement on acromion

58
Q

Static restraints of glenohumeral joint?

A
  • glenohumeral ligaments
  • glenoid labrum
  • articular congruity and version
  • negative intraarticular pressure
59
Q

Dynamic constraints of glenohumeral joint?

A
  • rotator cuff muscles
  • biceps tendon
  • periscapular muscles
60
Q

Function of superior glenohumeral ligament?

A

Resists inf subluxation at 0 deg abduction and neutral rotation

61
Q

Function of middle glenohumeral ligament?

A

Resists anterior/posterior translation at 45 deg abduction and ER

62
Q

Function of posterior inferior glenohumeral ligament?

A
  • resists posterior subluxation at 90° flexion and IR

- tightness leads to internal impingement and increased shear forces on superior labrum (linked to SLAP lesions)

63
Q

Function of anterior inferior glenohumeral ligament?

A
  • resists anterior/inferior translation at 90° abduction and maximum ER (late cocking phase of throwing)
  • anchors into anterior labrum
  • forms weak link that predisposes to Bankart lesions
64
Q

Function of superior inferior glenohumeral ligament?

A
  • most important static stabilizer about the shoulder joint

- 100% increased strain on superior band of IGHL in presence of a SLAP lesion

65
Q

Function of coracohumeral ligament?

A
  • primary stabilizer to posterior subluxation with shoulder in flexion, abduction, and internal rotation
  • limits inferior translation and external rotation at adducted position
66
Q

Glenoid labrum facts?

A
  • helps create cavity-compression and creates 50% of the glenoid socket depth
  • composed of fibrocartilagenous tissue
  • blood supply
    • suprascapular artery
    • anterior humeral circumflex scapular
    • posterior humeral circumflex arteries
    • labrum recieves blood from capsule and periosteal vessels and not from underlying bone
    • anterior-superior labrum has poorest blood supply
67
Q

Variants of glenoid labrum?

A
  • normal variant
    • attached to the glenoid rim and a flat/broad middle glenohumeral ligament
    • cord-like middle glenohumeral ligament is present in 86% of population
  • sublabral foramen seen in 12%
  • Buford complex seen in 1.5%
  • meniscoid appearance in 1%
68
Q

Buford complex?

A
  • variant of glenoid labrum seen in 1.5%
  • cordlike middle glenohumeral ligament with attachment to base of biceps anchor and complete absence of the anterosuperior labrum
  • attaching a Buford complex will lead to painful and restricted external rotation and elevation.
69
Q

Rotator interval anatomy?

A
  • capsule, SGHL, coracohumeral ligament that bridge the gap between the supraspinatus and the subscapularis.
  • boundaries
    • medially by lateral coracoid base
    • superiorly by anterior edge of supraspinatus
    • inferiorly by superior border of subscapularis
    • lateral apex formed by transverse humeral ligament
70
Q

Contracture of rotator interval?

A
  • seen in adhesive capsulitis
71
Q

Laxity of rotator interval?

A
  • appears as “sulcus sign” with inferior laxity with the shoulder in adduction
72
Q

Dynamic role of rotator cuff?

A
  • subscapularis is an important stabilizer to posterior subluxation in external rotation
73
Q

Dynamic role of biceps tendon in shoulder stability?

A
  • long head of biceps acts as humeral head depressor
  • has variable origin from superior labrum
    forms weak links that predisposes to SLAP tear
74
Q

Humeral head facts?

A
  • spheroidal in shape in 90% of individuals
  • average diameter is 43 mm
  • retroverted 30° from transepicondylar axis of the distal humerus
  • articular surface inclined upward 130° from the shaft
75
Q

Glenoid facts?

A
  • pear-shaped surface with average upward tilt of 5°
  • average version is 5° of retroversion in relation to the axis of the scapular body and varies from 7° of retroversion to 10° of anteversion
76
Q

Coracoid facts?

A
  • anatomic landmark (lighthouse) for deltopectoral approach

- coracobrachialis, pectoralis minor, and short head of the biceps attach to the coracoid

77
Q

Acromion facts?

A
  • 3 ossification centers
    • meta (base), meso (mid), and pre-acromion (tip)
  • acromiohumeral interval is 7-8mm
    • AHI decreased on MRI when pt is supine usually signifies multiple tendon tear.
  • acromial morphology
    I=flat
    II=curved
    III=hooked
78
Q

Humeral head blood supply?

A
  • major blood supply to humeral head
    • ascending branch of anterior humeral circumflex artery
    • arcuate artery provides
    • vessel runs parallel to lateral aspect of tendon of long head of biceps in the bicipital groove
  • posterior humeral circumflex artery provides blood supply to a portion of posteroinferior humeral head
79
Q

Arcuate artery of shoulder?

A
  • interosseous continuation of ascending branch of anterior humeral circumflex artery and penetrates the bone of the humeral head
80
Q

Little Leaguer’s Shoulder?

A
  • Salter Harris Type I physeal injury to proximal humerus in adolescent pitchers
    and tennis players
  • arm overuse causes repetitive microtrauma
    • from high loads of torque
    • breaking pitches are implicated
81
Q

Signs/symptoms of Little Leaguer’s shoulder?

A
  • arm and shoulder pain with throwing
  • worse in late cocking or deceleration phases
  • pain resolves with rest
  • may be associated with decreased velocity and control
  • point tenderness over shoulder physis
  • pain reproduced with shoulder rotation
82
Q

Imaging of Little Leaguer’s shoulder?

A
  • X-ray may show physeal widening or metaphyseal bony changes
  • MRI may show edema
83
Q

Treatment of Little Leaguer’s shoulder?

A
  • avoid pitching 2-3 months
  • PT for RC strengthening/post capsule stretching
  • correct pitching mechanics
  • avoid breaking balls
  • pitch counts
84
Q

Complications of Little Leaguer’s shoulder?

A
  • physeal growth arrest

- angular deformity

85
Q

Piriformis muscle syndrome?

A
  • extrapelvic compression of sciatic nerve
  • aka deep gluteal syndrome
  • entrapment anterior to piriformis muscle or posterior to obturator internus/gemelli complex
  • at level of ischial tuberosity
86
Q

Sings/symptoms of piriformis syndrome?

A
  • nonspecific and include pain in the posterior gluteal region and migrating down the back of the leg
  • pain may be burning or aching in nature similar to sciatica symptoms
  • FAIR test (flexion, adduction, and internal Rotation of hip) can reproduce symptoms
    • maneuver places piriformis muscle on tension
87
Q

Imaging for piriformis syndrome?

A
  • unremarkable

- EMG can diagnose sciatic pathology

88
Q

Treatment of piriformis syndrome?

A
  • mainstay is non-op
    • rest, PT, injections
  • operative tx for refractory cases to release piriformis and sciatic nerve neurolysis
89
Q

Most common anatomy of sciatic nerve as it exits pelvis?

A
  • single nerve anterior to piriformis and posterior to obturator internus and gemelli
90
Q

Most common anatomic variant of sciatic nerve as it exits pelvis?

A
  • split nerve, one anterior to piriformis and one through piriformis

Orthopaedic Board Study (6 decks)

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