Knee Surgery I

Front 1

a. How far does the joint capsule extend inferiorly? Why is this important?

Back 1

i. 15 mm distal to joint line
ii. Pin placement

Front 2

b. Where does the ACL attach to the tibia?

Back 2

i. Intercondylar tubercles (spines)

Front 3

c. What attaches on Gerdy’s tubercle?

Back 3

i. IT band

Front 4

d. What are the characteristics of the medial tibial plateau?

Back 4

i. Oval and concave

Front 5

e. What are the characteristics of the lateral tibial plateau?

Back 5

i. Circular and convex

Front 6

f. What tibial plateau is more sensitive to meniscal insufficiency and fracture?

Back 6

i. Lateral

Front 7

a. Where is the common peroneal nerve with respect to the fibula?

Back 7

i. Wraps around head and neck

Front 8

a. What does the ACL provide?

Back 8

i. Stability to anterior and rotational force

Front 9

b. What are the two bundles of the ACL?

Back 9

i. Anteromedial
ii. Posterolateral

Front 10

c. What does the PCL provide?

Back 10

i. Stability to posterior force

Front 11

d. What are the two bundles of the PCL?

Back 11

i. Anterolateral
ii. Posteromedial

Front 12

e. What does the posterolateral corner provide?

Back 12

i. Stability to rotational movement

Front 13

f. What is in the posterolateral corner?

Back 13

i. Arcuate ligament
ii. Popliteus
iii. Posterolateral capsule
iv. LCL
v. Popliteofibular ligament
vi. Lateral head of gastroc

Front 14

g. What are the attachments and function of the deep MCL?

Back 14

i. Medial epicondyle to medial meniscus
ii. Hold medial meniscus to femur

Front 15

h. What are the attachments and function of the superficial MCL?

Back 15

i. Medial epicondyle to medial tibia
ii. Resists valgus force

Front 16

i. What are the attachments and function of the LCL?

Back 16

i. Lateral epicondyle to fibular head
ii. Resists varus force

Front 17

j. What are the attachments and function of the ACL?

Back 17

i. Lateral wall of intercondylar notch to anterior intercondylar tibia
ii. Resist anterior/rotational force

Front 18

k. What are the attachments and function of the PCL?

Back 18

i. Medial wall intercondylar notch to posterior tibial sulcus
ii. Resist posterior force

Front 19

l. What are the attachments and function of the intermeniscal ligaments?

Back 19

i. Anterolateral meniscus to anteromedial meniscus
ii. Stabilizes menisci

Front 20

m. What are the attachments and function of the coronary ligaments?

Back 20

i. Meniscus to tibial periphery
ii. Meniscal attachment

Front 21

a. What is the red-red zone of the menisci?

Back 21

i. Outer 1/3-- vascular

Front 22

b. What is the red-white and white-white zone of the menisci?

Back 22

i. Inner 2/3

Front 23

c. What is the function of the menisci?

Back 23

i. Deepen the concavity of tibial facets

Front 24

d. What type of meniscal tear is most common? Why?

Back 24

i. Medial
ii. Less mobile

Front 25

e. When will you most often see a lateral meniscus tear?

Back 25

i. With ACL tears

Front 26

a. What are the characteristics of the articular cartilage in the knee?

Back 26

i. Low coefficient of friction
ii. Alymphatic, aneural, avascular

Front 27

b. What makes up the articular cartilage of the knee?

Back 27

i. Water (65-80%)
ii. Chondrocytes
iii. Matrix

Front 28

c. What increases the water content of articular cartilage?

Back 28

i. Osteoarthritis

Front 29

d. What does collagen provide to the articular cartilage?

Back 29

i. Tensile strength

Front 30

e. What type of collagen is predominant in articular cartilage?

Back 30

i. Type II

Front 31

f. What type of collagen is in hypertrophic chondrocytes during cartilage growth?

Back 31

i. Type X

Front 32

g. What provides compressive strength to articular cartilage?

Back 32

i. Proteoglycans

Front 33

h. What makes up proteoglycans?

Back 33

i. GAGs
ii. → Chondroitin sulfate
iii. Keratin sulfate

Front 34

i. What is an aggrecan molecule?

Back 34

i. GAGs bound to protein core

Front 35

j. What makes up an aggregate molecule?

Back 35

i. Aggrecan bound to HA

Front 36

k. What type of cartilage injury heals? How does it heal?

Back 36

i. Deep injury
ii. Fibrocartilage production→ scar

Front 37

l. What type of cartilage injury does not heal?

Back 37

i. Superficial

Front 38

a. What does a good knee exam begin with?

Back 38

i. Good history

Front 39

b. Where should you palpate in a knee examination?

Back 39

i. Joint lines
ii. Patellar tendon
iii. Quadriceps tendon
iv. Pes anserine bursa
v. Fibular head
vi. Popliteal space
vii. Gerdy’s tubercle

Front 40

c. What is the most accurate dx test for a meniscal tear?

Back 40

i. Tenderness upon palpation of joint lines

Front 41

d. How do you measure ROM?

Back 41

i. Goniometer

Front 42

e. How do you perform a Lachman test?

Back 42

i. Flex to 30 degrees, pull tibia anteriorly
ii. Compare to contralateral side

Front 43

f. What is a Lachman grade 0?

Back 43

i. No difference

Front 44

g. What is a Lachman grade 1?

Back 44

i. 1-5 mm difference

Front 45

h. What is a Lachman grade 2?

Back 45

i. 5-10 mm difference

Front 46

i. What is a Lachman grade 3?

Back 46

i. > 10 mm difference

Front 47

j. What should you feel for in a Lachman test? How do you confirm?

Back 47

i. Endpoint
ii. KT-1000

Front 48

l. How do you do an anterior drawer test?

Back 48

i. Flex to 90 degrees
ii. Use Lachman grading

Front 49

m. What is a posterior drawer grade 0?

Back 49

i. Normal

Front 50

n. What is a posterior drawer grade 1?

Back 50

i. Normal step off

Front 51

o. What is a posterior drawer grade 2?

Back 51

i. Flush with tibial plateau

Front 52

p. What is a posterior drawer grade 3?

Back 52

i. Sags posterior to plateau

Front 53

q. How do you perform a pivot shift test?

Back 53

i. Start extended
ii. Internally rotate
iii. Axial load
iv. Flex slowly

Front 54

r. What is the sign of a positive pivot shift?

Back 54

i. Clunk

Front 55

s. What does the pivot shift test look for?

Back 55

i. ACL disruption

Front 56

t. What is valgus and varus stress test used for?

Back 56

i. Collateral ligament injury

Front 57

u. How do you perform a valgus/varus stress test?

Back 57

i. 0 and 30 degrees of flexion
ii. If tibia comes up and the rest of the leg doesn’t, then its positive

Front 58

v. What is a McMurray’s test? How do you perform it?

Back 58

i. Meniscal test
ii. Fully flex, internally rotate
iii. Pain and/or click is positive

Front 59

a. What are the Ottawa knee rules for an x-ray?

Back 59

i. Age >55
ii. Tenderness at head of fibula
iii. Isolated tenderness at patella
iv. Inability to flex knee 90 degrees
v. Inability to bear weight four steps immediately and in examination room

Front 60

b. What are T1 MRIs weighted to?

Back 60

i. Fat

Front 61

c. What are T2 MRIs weighted to?

Back 61

i. Water

Front 62

a. What MRI is best for anatomy?

Back 62

i. T1

Front 63

e. What MRI is best for pathology?

Back 63

i. T2

Front 64

f. What three cuts should you get in an MRI?

Back 64

i. Axial
ii. Sagittal
iii. Coronal