Abos - Knee & Tibia/fibula - Knee: Pathologic States - Anterior Cruciate Ligament Injuries & Reconstruction

Front 1

What is the most common mechanism of ACL injury?

Back 1

Noncontact pivot

Front 2

What gender is most at risk for sustaining an ACL injury?

Back 2

Female

Front 3

How often does an acute bloody knee effusion correlate with a ruptured ACL?

Back 3

75%

Front 4

What test is most sensitive on physical examination for ACL rupture?

Back 4

Lachman test

Front 5

What is clinically significant KT-1000 (arthometry) difference side-to-side?

Back 5

3 mm

Front 6

Once the ACL is disrupted, what is the primary restraint to anterior translation?

Back 6

Meniscus

Front 7

What plain radiographic finding is classically associated with an ACL injury?

Back 7

Segond fracture

Front 8

What is the MRI appearance of a bloody effusion? Non bloody effusion?

Back 8

Bloody: high T1, low T2
Non-bloody: low T1, high T2

Front 9

What are the three preoperative requirements to minimize the risk of arthrofibrosis?

Back 9

Full range of motion (ROM)
No effusion
Good quadriceps function

Front 10

With a preoperative varus thrust, what procedure should be considered before ACL reconstruction?

Back 10

High tibial osteotomy (HTO)

Front 11

Of the graft options, which has the highest ultimate tensile load?

Back 11

Quadrupled hamstring

Front 12

What two hamstring tendons are used as graft for reconstruction?

Back 12

Gracilis
Semitendinosus

Front 13

What nerve is at risk with hamstring harvest?

Back 13

Sartorial branch of the saphenous nerve

Front 14

What graft option has strength characteristics most similar to those of the native ACL?

Back 14

Bone-patellar tendon-bone

Front 15

What nerve is at risk with patellar tendon harvest?

Back 15

Infrapatellar branch of saphenous nerve

Front 16

In which direction is an intraoperative patellar fracture generally oriented?

Back 16

Vertical

Front 17

How can the strength of the graft be increased by about 30%?

Back 17

Rotate 90 degrees

Front 18

What is the benefit of preconditioning the graft?

Back 18

Reduces stress relaxation by 50%

Front 19

What are the two most reliable tibial tunnel landmarks?

Back 19

Just anterior to PCL
Native ACL footprint

Front 20

In which direction is a postoperative patella fracture generally oriented?

Back 20

Horizontal

Front 21

At 6 weeks after surgery, what percentage of original graft strength has returned? At 1 year?

Back 21

<20% of original at 6 weeks
<50% of original at 1 year

Front 22

After ACL, what rehabilitation exercises are preferred? What is the goal of rehabilitation? What type of training is emphasized? Are prone hangs permissible?

Back 22

Closed chain, weight bearing as tolerated (WBAT) exercises
Safe quadriceps strengthening
Emphasizes proprioceptive training
Prone hangs are OK

Front 23

What is the worst ACL postoperative exercise? What is the ideal PCL postoperative exercise?

Back 23

Worst ACL: active extension 15 to 30 degrees
Ideal PCL: active extension 90 to 0 degrees

Front 24

What four factors have been associated with good 2 -year outcomes after ACL reconstruction?

Back 24

Accurate tunnel placement
Strong grafts
Solid graft fixation
Rational rehabilitation program

Front 25

What is the most common cause of immediate postoperative ACL failure?

Back 25

Failure of fixation

Front 26

What is the most common operative complication overall?

Back 26

Aberrant tunnel placement

Front 27

What is the upper limit of acceptable screw divergence?

Back 27

20 degrees

Front 28

What is the consequence of a too anterior femoral tunnel?... tibial tunnel?

Back 28

Femoral tunnel too anterior: decreased flexion
Tibial tunnel: impingement in extension

Front 29

If the femoral tunnel is too far back (over top), what is the consequence in flexion?... extension?

Back 29

Lax in flexion
Tight in extension