Mrc - Lower Extremity Sports

Front 1

Knee innervation

Back 1

posterior articular branch of posterior tibial nerve

Front 2

articular cartilage

Back 2

Type II collagen, mostly water; increased water and decreased PG’s in DJD

Front 3

ACL features

Back 3

33mm x 11mm; AM tight in flexion, PL tight in extension; Middle Geniculate Artery

Front 4

PCL features

Back 4

38mm x 13 mm; AL (tight in flexion), PM (tight in extension); AL is the one to reconstruct if doing single bundle

Front 5

Meniscofemoral ligaments

Back 5

Humphrey (anterior), Wrisberg (posterior)

Front 6

Knee capsules most distal extent

Back 6

just posterior of fibula

Front 7

Ligament strength in knee

Back 7

MCL>PCL>ACL>LCL

Front 8

Posterolateral corner

Back 8

superficial- Biceps and IT band, deep LCL, popliteus, popliteofibular ligament

Front 9

Popliteus

Back 9

internally rotates the tibia, checkrein to external rotation; popliteus insertion is distal, anterior, deep to LCL

Front 10

Key restraint to lateral translation of patella

Back 10

Medial patello-femoral ligament

Front 11

Meniscus

Back 11

Type I collagen, more excursion laterally than medially; lateral horn attaches near the ACL

Front 12

Fall on PF foot versus DF foot

Back 12

Fall PF foot, PCL injury, Fall DF foot Patella injury

Front 13

exam collaterals

Back 13

varus or valgus stress at 30 deg flexion

Front 14

Pivot shift

Back 14

IT band is a flexor when knee is flexed greater than 30 degrees; essentially IT band reduces anteriorly subluxed knee

Front 15

PLC exam

Back 15

ER asymmetry; side to side difference; if increased ER only at 30 deg then isolated PLC; if increased at 30 and 90, combined PLC and PCL

Front 16

Quadriceps active exam

Back 16

tibia that is sagging in PCL injury- when ask patient to extend knee, quads pull reduces sagged tibia

Front 17

Segund sign

Back 17

lateral capsule avulsion fracture- associated w/ ACL tear

Front 18

Widening and cupping of lateral tibia

Back 18

discoid meniscus

Front 19

Importance of stress fractures post knee injury

Back 19

Posterior translation in PCL injury; look for physeal fracture in children, can be useful for LCL & MCL injury

Front 20

Tibial Tubercle to Trochlear Groove offset (TT-TG)

Back 20

difference between TG apex to ATT apex, etc, etc.; if >20, consider medialization tibial tubercle (Fulkerson)

Front 21

Double PCL sign

Back 21

bucket handle meniscus tear

Front 22

Meniscus repair

Back 22

best in Red-Red; vertical mattress inside out technique best; medially must watch for saphenous nerve vein, lateral side common peroneal nerve

Front 23

Meniscus transplant contra-indication

Back 23

grade IV chondromalacia

Front 24

Discoid meniscus

Back 24

if come across asymptomatic discoid meniscus, leave it alone; if there are tears, do standard minimal debridement

Front 25

Osteochondritis Dissecans (open physis)

Back 25

most common location lateral aspect MFC; non-weight-bearing 6-12 weeks; only after failing non-op do you do surgery

Front 26

Microfracture pearls

Back 26

must remove calcified cartilage layer

Front 27

Plicae

Back 27

medial plicae most common, and only indication for debridement is if it is abrading of MFC

Front 28

ACL gait abnormality

Back 28

quadriceps avoidance gait

Front 29

Graft choice in ACL

Back 29

bone PT bone: risk for knee pain; strongest is quadrupled hamstring

Front 30

Radiation sterilization allografts

Back 30

> 3 Mrads to kill HIV; weakens graft

Front 31

Hamstring harvest

Back 31

avoid graft amputation, saphenous nerve (between gracilis and sartorius), may have some loss terminal flexion strength

Front 32

ACL tunnel placement

Back 32

10-10:30 position to reconstruct PL bundle and correct pivot shift

Front 33

ACL bracing

Back 33

no benefit except in skiers

Front 34

PCL tear treatment

Back 34

Non-op OK if isolated PCL; if combined PCL and PLC injury, reconstruct BOTH;

Front 35

Treatment MCL injury

Back 35

Hinged knee brace for 6-8weeks (30 degrees if isolated injury)

Front 36

Knee dislocation and vascular studies

Back 36

arteriogram mandatory if absent/diminished pulses or if ABI < 0.9

Front 37

Proximal tib-fib dislocation

Back 37

immobilize in extension

Front 38

HTO’s

Back 38

do long leg x-rays, try to get mechanical axis 62% into contralateral compartment

Front 39

HTO in ACL deficiency

Back 39

decrease tibial slope

Front 40

HTO in PCL deficiency

Back 40

increase tibial slope

Front 41

Prepatellar bursitis in wrestlers

Back 41

aspirate to R/O infection

Front 42

Lateral dislocation patella

Back 42

medial facet patella chondral injury 95%; rupture of MPFL

Front 43

Lateral release indications

Back 43

needs lateral tilting on objective exam (arthroscopic) or radiography, failure of physical therapy

Front 44

Reverse pivot shift

Back 44

subluxed posteriorly in flexion and reduces with extension

Front 45

Initial treatment PCL injury

Back 45

non-operative

Front 46

isolated PLC injury exam finding

Back 46

increased ER in 30 degrees only (not in 90 degrees, which would be indicative of PCL injury)

Front 47

Snapping hip syndrome causes

Back 47

external (IT band), internal (iliopsoas), intra-articular (labral tear or loose body)

Front 48

Hip arthroscopy complications

Back 48

usually related to traction; anterior portal has risk of lateral fem cutaneous nerve injury

Front 49

Loss of motion in Femoral-acetabular Impingement

Back 49

loss of flexion and internal rotation

Front 50

Treatment of Abterior tibia stress Fracture

Back 50

IM nail for “dreaded black line”

Front 51

Navicular linear stress Fx

Back 51

compression screw

Front 52

Stress Fx metatarsal with hypertrophic callus- treatment

Back 52

restricted weight bearing followed by slow return to play

Front 53

Exertional compartment syndrome

Back 53

most common anterior; watch for the superficial peroneal nerve 10-12 cm proimal to the lateral malleolus

Front 54

Superficial peroneal nerve entrapment

Front 55

Adolescent avulsion fractures

Back 55

rectus, sartorius, hamstrings; Fix if greater than 3cm displacement in very active patient

Front 56

FHL injury or irritation

Back 56

decreased great toe passive flexion in neutral, but normal in plantar flexion

Front 57

Os associated with chronic ankle instability

Back 57

Os subfibulare- may be small avulsion fracture

Front 58

Painful os in dancers

Back 58

Os trigonum

Front 59

Ottawa Ankle Rules

Back 59

Distal /post tenderness, navicular tenderness, inability to weight bear, age >55 years

Front 60

Chronic ankle instability Tx

Back 60

Anatomic reconstruction such as modified Brostrum

Front 61

Snowboarders fracture

Back 61

lateral process talus

Front 62

Ankle arthroscopy portal risks

Back 62

Antero-lateral (superficial peroneal nerve), antero-medial (saphenous vein)

Front 63

Jones Fractures- how to fix

Back 63

ORIF (intra-meduallary screw 4.5mm or greater)

Front 64

Diagnosis of exertional compartment syndrome

Back 64

pre and post exertional compartment pressures, >15 at rest, >30 after exertion

Front 65

Diagnostic test for possible syndesmosis injury

Back 65

external rotation stress view

Front 66

Recreational athletes

Back 66

do not treat aggressively like you would professional athlete

Front 67

Turf toe sequelae

Back 67

Hallux rigidus

Front 68

% Stress relaxation prevented by pretensioning ACL allograft

Back 68

50%

Front 69

What is the primary restraint to inferior glenohumeral translation or external rotation with arm adducted?

Back 69

coracohumeral ligament