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139 Cards in this Set

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Portals should be separated as widely as possible, consistent with the anatomy, ot avoid this?
Skin necrosis due to the portals place too close ot each other.
If an instrument fails or breaks within the joint, what should be done immediately?
Outflow of aline should be shut down while the inflow is left open to keepthe oint distended for retrieval of the broken piece.
What anatomical structures are consedered when making an anterolateral portal?
beween the extensor digorum longus and the the superficial peroneal nerve.
When is the ransmalleolar appoach for lesions of the talus contraindicate?
In children with open eiphyses
What anatomical structures shoudl be consedred when making an danteromedial portal?
Between the saphenou vein and the tibialis anterior tendon.
When is the transmaleolar approach for lesions fo the talus contraindicated
in children with open epiphyses
what is the most common size and angulatin of an arthroscope used in an ankle?
2.7 mm and 30 degrees or zero degrees of angulation
What is the minimum distance an accessory portal shuld be placed between the two working portals?
At least 1 cm apart to avoid ski nnecrosis.
How would one confirm that the loose body seen on x-ray is intra-articular instead of intra capsular or extra-articular?
Perform an arthrogram, perhaps in combination with a CT or MRI.
In anterior soft tissue impingement of the ankle, pathology is generally limited to what?
The syndesmosis and the lateral gutter.
When usin ghte posterolateral approach one shuuld avoid what anatomical structures?
subcutaneous sural nerve or the short saphenous vein. Als avoid entering the STJ.
In an terior soft tissue impingement of the ankle, pathology is generally limited t what?
the synesmosis and the lateral gutter.
When using the poterolateral approach, one hsould avoid what anatomical structures?
subcutaneous sural nerve or the short saphenous vien. Also avoid entering the StTJ.
Transmalleolar portals are more often required on which side of the ankle joint and why?
On the medial side because lateral dome lesions are more anterior than on the medial side,k and because the lateral malleolus i furhter posterior than the medial malleolus.
what ar ethree basic joint surveying techniques in ankle arthroscopy?
scanning, pistoning and rotationg
prior to beginning arthroscopy, which portal is develped first?
The medial portal is developed first adn the scope is placed in to survey the joint prior to lateral ortal development.
What are the colntrainications for manual distraction and or gravity distraction?
Tight ankles ptahology not easily accessible, and proloned procedures.
What arthe contraindicatoins to the use of non-invasive distraction?
Impaired circulatory status, diabetes, generalized medical conditions, ankle edema, or gragile skin.
What are three basic joint surveying techniques in ankle arthroscopy?
scanning, pistoning, and rotating.
Prior to beginning arthroscopy, which portal is develope dfirst?
The medial portal is developed frist and the scope is placed i to surey the joint porior ot lateral portal development
What are the contraindications for manual distraction and/or gravity distraction?
Tight ankles, pathology not easily accessible, and proloned procedures
What ar the contraindications to the use of non-invasive distraction?
impaired circulatory status, diabetes, generalized medical conditions, ankle edema, or fragile skin
What ar the contraindications to the use of skeletal distraction?
local or generalized infections, osteopenia, openepihysis, and lax ligaments.
What are the contraindication to the use of skeletal distraction
locla or generalized infections, nosteopenia, open epihysis, and lax ligaments
What are some the indiecatiosn for the use of single heavy pin disraction (3/16 inch)?
Large bone structure in males, long caes or difficult pathology, bery tight ankles, ankle arthrodesis, etc.
Whata re some advatages of double pin (7/64 inch) distraction
better control, less stres riser than 3/16 inch, less chance of pin tract infection.
What are the recommended parameters of force and druation for non-invasive distraction?
20-25 lbs of force for about 30-45 minutres.
What are the parameters for proximal pin placement in skeletal distraction?
3/16 in 7/64 in insered 2 inches; 2 1/4 up to 4 inches above ankle joint usually from the lateral side.
What ar eth e three insertion sites for distal pin placement in skeletal distractionj?
tow i nthe calcanedus and one hte talus.
How is the distal pin inserted int he clacaneus ?
It is inserted at a 20-35 degree downaward slope so that when distraction occurs the pin will become parallel with the proximal pin
what size of pin is used i nlight double distraction mode?
7/64th smooth pins
what size of pin is used in heavy single of double distraction?
3/16 threated pin
When a 3/16 invasive distaction used, how long post operatively should the patient avoid atheletic activiy or heavy work?
WITH HEAQVY DISTRACTION, THE PATEINT SHOULD AVOID ATHLETIC ACTIVY OR HEAVY WORK FOR 8-10 WEEKS TO DECREAE THE RISK OF FRACTURE.
When 7/64 invasive distraction is used, when can the paitent reuturn to activity?
four to six weeks.
Whyat type of specific synovitsi occurs in three stages?
chronic synovial chndromatosis.
which disease entitiy is characterized by synovitis with advanced paillary formation and hemosdierin cells present?
pigmented villonodular synovitis.
Osteochondral lesion of the talar dome are commonly foun where?
commonly found at he anterior lateral spect or the posterior medial aspect of the dome.
What is themechanism of injury in a medial talar dome osteochondral lesion?
Inversion of the foot with ankle plantarflexed.
What ti sthe mechanism of injur in a lateral talar dome osteochondral lesion?
inversion of the foot with the ankle dorsiflexed and the tibia internally rotated.
What is the mechanism fo injury in a medial talar dome osteochondral lesion?
inversion of the foot with ankle plantarflexed.
How should a bone graft be palced in gthe articualr cartilage of the talar dome?
the graft should be placed 1-2mm below the level of the articular cartilage.
What is one method that has been proven helpful in viewing chondral lesions of the ankle joint?
the use of methylene blue dye injected into the joint and then washed out with irrigant saline
What technique is use d in arthrcopic ankle arthrodesis?
arthroscopic transmalleolar cross-screw fusion.
What are some adavatages of the artrhroscaopic approach to anke fusion over the oopen mnethod?
less surgical morbidity and improved cosmesis.
What are the disasvangages of the arthroscopic approach to ankle fusion?
sever varus/valgus malalignment is difficult ot correct arthroscopically.
what is a contraindication to doing arthrscopic ankle fusion?
a varus / valgus malalignemnt greater than 15 degrees.
What type and size of screw is used in an arthroscopic ankle fusion to fuse the nakle?
cannulated 6.5 mm cancellous screw system.
What are considered abnormal values i nthe anterio drawer stres test?
between 5-10 mm of anter displacement of hte talus from the distal tibia are consdiered abnormal, and over 10 mm of displacement are consdiered grossly abnormal. In comparison with the unaffected extemiety theinjured ankle should have an anterior drawer test result of 3 mm or more to be consedired significant.
Name the arthroscopic technique that involves insetion of another object suh as a probe beside a target structio into th efield of view on the arthroscope in orde for the physician t better conceptualize the relative positions fo these objeccts to one another of the adjacent structures.
triangulation.
Which side of the anterior half of the talar doem usually produces a shallow wafer shaped fractue?
lateral
Which side of the posterior therid of the talar dome is subject to deep cup shaped lesions
medial
What is th eprocedure for sterilzation of an arthroscope?
first case - ethylene oxid gass, additional cases - activated glutaradlehyde solution for 20 minuts. Arthroscopes cannot be autoclaved.
What si the probable dignosis if ony 10-12 ml of saline can be injectied intot th e nakle joint capsule f a normal sized adult?
capsular adhesion or bibrosis
plantar flexion of hte foot increases the visualization for which group of arthroscopic portal approaches
anterior.
Dorsiflexion of the foot increases the visualization for which group of arthroscopic portal approaches
psoterior
Name the indcatiosn for ankle joint arthroscopy
chronic ankloe isntability, persisten ankle joint pain, ankle fracutes, ankel fusions, arthritis, adhesive caspulitis, synovits, meiscoid boides, chrondormalcia, chondral and osteochondraal defects, arteri impingement exoxtosis, anmd pre-oprative planning
Name and describe thre three principles or nameuvers perforned in arthroscopy
pisotnin is the moviemnt of the arthroscope toward or away from an object. Pistoning toward an object would increase the objects apparent size whil decresing the toal field of visoin
scanning o sweeping is the side to side or up and down omvement of the qarthroscope to get a more complete view of a jont . The ideas is to go from known to unkown areas of the joint ot disinguish normal from pahaological structures.
Rotation is the movment of the arthroscope about is axis. The filed of vision is changed depending on the obliquiety of the arthroscope tip. The arge the degree of tip cut, the wider the field
The first perosonto perform and endoscopic intra-articular observation (1918) and also the firswt successful ankle arthroscopy?
takagi - university of tokyo
What instrument ahs a sharp point and is used to peirce soft tissue and capsuel?
troca
What instrumen has a blunt pint and is ued to enta a jont? WHy?
obturator to pervent iotrogenic carialgniosu damage
ARthroscopoes are available in what size
1.7 to 8.0mm
What is used to distend the ankle jont and maintain a clean field for the came?
irrigation system of normal salin.
For chorndormalacia o, ostoechondral defects, and osteorarthritis, burrs are sued to abarde articular defects to what level
viable bleeding bone
What structue is the landmark for locating the propelr site ofr an anteromedial portal appoach for an ankel arhtoscopy;
tinbialsi anteri tendon (must go medial to it)
What is used to distend the ankle jont and maintain a clean field for the camera
irrigation system of normal saline
For chbondormalacia, osteochondara defects, and osteoarthrits, burss are used to abrade articular defects to what level
viable bleeding bone
What struhure is the landmark for lcatin gthe proper site for an anteromedialportal appaoach fror an ankel arthroscopy
tibialis anterio tendon
an naterocentral protal is always located lateral to what structuer?
EHL
What nerves are at reisk of bieng injured with the five idffent portals of ientry into the ankle jont
anteromeidal - saphenous nerve
anterocentral - deep peroneal nerve
anterolateral - terminal branches of superfidal peroneal nerve
posterio medial -osterior tiebial nerve
posteriro lateral - sural neerve
What is the prupose of stopcock, on the seidar of a cannula
the ingress or egress of fluids
What er the three types of light sources used in arthroscopy
senon, quartz halogen, incandscent (tungsten halogen)
The tree main type sof motorized shower tips attach to hand engins of power arthocopy instrumentation ar ethe open ended, side -cutter, and full radus,. Whic tip contains a normal rotation blade that prevent inaadvertntdamage to cartialge? whic tip is themost aggressive?
The full raidus typ of tip has aroudn rotating blade
Teh open endid tip is the ost aggresive type becasue the endo fhte blade is comelety exosed
Are the fluetes itn ehs pher of an abrader more aggesive in cuttin in aforward or reverwse dierectin?
forward
How does the force of suciton affect the aggresivens of ashb e? and abader
it increase the aggresivenes of both by aspriatin mor etissuse into the opeing s at hthe nend of ithe inastruments.
How does the speed of rotations iof its blades affect a shave? an abrader?
The slwer a shaver ottes the more aggresively it cuts.
The faster an abrader moves the more aggressively it cuts
What two bones are th emcanical dstraction system hooked into?
lwoer tibia an d hte calcaneus
What areidographic veiw is usded to evaluate and anteror drawer test
lateral
How many degrees of varus tialt are need befoer and inversiotn stress test cosneered abnormasl
15 degrees whencompared ot the unaffeccted anke
Waht radiographic projection is used to evalute and inversion streesss test?
AP projeciton
What color or appearance does synovia fluid have normallyh? In an inmammatory process? in the presenco fo gout orheujmatoid arthitis?
Normallyy - clear ligh, pale yellow
with inflammatin, tubid,
with gbout or rheumatoid arthitis milkey
how is size of an arthroscope dettermined?
by the diameter of thecsting that contains the lens system
What determins the obliquity or direction fo the field of vew seen through an arthroscope
the tip cut of the endo f the arthroscope
Whata rethe two commonly used lens systems for arthroscopes?
Rod lesn (HOking)
and hte GRIN (gradient index)
Abrasion arthroplasty resects necrotic islnand so fcartlage and or subcohnodr bone to what depth? why?
1.0 mm ( to the level of the tidemark) bleow the surface of sbchondral bone. Because this si the area that ocntains the vasuclarity that provide nutrition to suppor grwoth of new healthy hyaline cartilag.e
How does the speed of rotations iof its blades affect a shave? an abrader?
The slwer a shaver ottes the more aggresively it cuts.
The faster an abrader moves the more aggressively it cuts
What two bones are th emcanical dstraction system hooked into?
lwoer tibia an d hte calcaneus
What areidographic veiw is usded to evaluate and anteror drawer test
lateral
How many degrees of varus tialt are need befoer and inversiotn stress test cosneered abnormasl
15 degrees whencompared ot the unaffeccted anke
Waht radiographic projection is used to evalute and inversion streesss test?
AP projeciton
What color or appearance does synovia fluid have normallyh? In an inmammatory process? in the presenco fo gout orheujmatoid arthitis?
Normallyy - clear ligh, pale yellow
with inflammatin, tubid,
with gbout or rheumatoid arthitis milkey
how is size of an arthroscope dettermined?
by the diameter of thecsting that contains the lens system
What determins the obliquity or direction fo the field of vew seen through an arthroscope
the tip cut of the endo f the arthroscope
Whata rethe two commonly used lens systems for arthroscopes?
Rod lesn (HOking)
and hte GRIN (gradient index)
Abrasion arthroplasty resects necrotic islnand so fcartlage and or subcohnodr bone to what depth? why?
1.0 mm ( to the level of the tidemark) bleow the surface of sbchondral bone. Because this si the area that ocntains the vasuclarity that provide nutrition to suppor grwoth of new healthy hyaline cartilag.e
How does the speed of rotations iof its blades affect a shave? an abrader?
The slwer a shaver ottes the more aggresively it cuts.
The faster an abrader moves the more aggressively it cuts
What two bones are th emcanical dstraction system hooked into?
lwoer tibia an d hte calcaneus
What areidographic veiw is usded to evaluate and anteror drawer test
lateral
How many degrees of varus tialt are need befoer and inversiotn stress test cosneered abnormasl
15 degrees whencompared ot the unaffeccted anke
Waht radiographic projection is used to evalute and inversion streesss test?
AP projeciton
What color or appearance does synovia fluid have normallyh? In an inmammatory process? in the presenco fo gout orheujmatoid arthitis?
Normallyy - clear ligh, pale yellow
with inflammatin, tubid,
with gbout or rheumatoid arthitis milkey
how is size of an arthroscope dettermined?
by the diameter of thecsting that contains the lens system
What determins the obliquity or direction fo the field of vew seen through an arthroscope
the tip cut of the endo f the arthroscope
Whata rethe two commonly used lens systems for arthroscopes?
Rod lesn (HOking)
and hte GRIN (gradient index)
Abrasion arthroplasty resects necrotic islnand so fcartlage and or subcohnodr bone to what depth? why?
1.0 mm ( to the level of the tidemark) bleow the surface of sbchondral bone. Because this si the area that ocntains the vasuclarity that provide nutrition to suppor grwoth of new healthy hyaline cartilag.e
How does the speed of rotations iof its blades affect a shave? an abrader?
The slwer a shaver ottes the more aggresively it cuts.
The faster an abrader moves the more aggressively it cuts
What two bones are th emcanical dstraction system hooked into?
lwoer tibia an d hte calcaneus
What areidographic veiw is usded to evaluate and anteror drawer test
lateral
How many degrees of varus tialt are need befoer and inversiotn stress test cosneered abnormasl
15 degrees whencompared ot the unaffeccted anke
Waht radiographic projection is used to evalute and inversion streesss test?
AP projeciton
What color or appearance does synovia fluid have normallyh? In an inmammatory process? in the presenco fo gout orheujmatoid arthitis?
Normallyy - clear ligh, pale yellow
with inflammatin, tubid,
with gbout or rheumatoid arthitis milkey
how is size of an arthroscope dettermined?
by the diameter of thecsting that contains the lens system
What determins the obliquity or direction fo the field of vew seen through an arthroscope
the tip cut of the endo f the arthroscope
Whata rethe two commonly used lens systems for arthroscopes?
Rod lesn (HOking)
and hte GRIN (gradient index)
Abrasion arthroplasty resects necrotic islnand so fcartlage and or subcohnodr bone to what depth? why?
1.0 mm ( to the level of the tidemark) bleow the surface of sbchondral bone. Because this si the area that ocntains the vasuclarity that provide nutrition to suppor grwoth of new healthy hyaline cartilag.e
How does the speed of rotations iof its blades affect a shave? an abrader?
The slwer a shaver ottes the more aggresively it cuts.
The faster an abrader moves the more aggressively it cuts
What two bones are th emcanical dstraction system hooked into?
lwoer tibia an d hte calcaneus
What areidographic veiw is usded to evaluate and anteror drawer test
lateral
How many degrees of varus tialt are need befoer and inversiotn stress test cosneered abnormasl
15 degrees whencompared ot the unaffeccted anke
Waht radiographic projection is used to evalute and inversion streesss test?
AP projeciton
What color or appearance does synovia fluid have normallyh? In an inmammatory process? in the presenco fo gout orheujmatoid arthitis?
Normallyy - clear ligh, pale yellow
with inflammatin, tubid,
with gbout or rheumatoid arthitis milkey
how is size of an arthroscope dettermined?
by the diameter of thecsting that contains the lens system
What determins the obliquity or direction fo the field of vew seen through an arthroscope
the tip cut of the endo f the arthroscope
Whata rethe two commonly used lens systems for arthroscopes?
Rod lesn (HOking)
and hte GRIN (gradient index)
Abrasion arthroplasty resects necrotic islnand so fcartlage and or subcohnodr bone to what depth? why?
1.0 mm ( to the level of the tidemark) bleow the surface of sbchondral bone. Because this si the area that ocntains the vasuclarity that provide nutrition to suppor grwoth of new healthy hyaline cartilag.e ---- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- ----
How far above the paitn msut gags used for a gravity ingress system be lpalced?
2-3 meters
if visualization fo the anke jont is noet adquate usign the anteroentral portal, which anterio poertal is the best alternive? why?
anetromedial mbeause of a laco of ligamentosu structus and ue ot the fract that iha ahs thelawse amosunt of pahtolyg sasociate with it. Therefore it is lees apto to have hperthrophnic snoyuvail tissue iwhti it.
What type of paortal allows for flusing and rinso of ajoint?
egrees portal
What is the term used to describe soft tisuse patholgoy that involce the yherptroph of neormal antaotomic strucurs ecnodary to the inflammatory precess?
impingement syndreome
of ligament , joints capsusle and synovia menbranes, whic deos not hav a rich supply of nerves?
synovial membrane
How woudl and acute synovits appear diffentyly form achonic synovits arhtorsopically?
acutge synovitis presents with long transparent hypertorpohic villi and of uniform length with and enlarge dental vess (inject) or avessel that has rupture (hermoagic hypertorpohic synovitis)
chornic hypertorphic synovits is netier transparent no hemrrahgeic and present with frayed opaque vili of diffent lenghts secondary to necrosie if ther itips.
Fibers of what ligament makeu p the floor of the meidal gutter?
anteir tibiotalar ligaemnt of the deep deltoid
The medial ben is par to fhte antomy of what bone?
the tibia
What is the name of the deprression in the talra sruface that runs form anteri to psoter near the anterocetnar prot oion o fhte ankle jont?
sagittal groove
The m anterio tibial lip is made of what substance.
perisoteum coverd subcnhondrfal bone
What is the name of htarea between the tibial tubercle, the fibular, and the laterl shoulder of hte talus
the lateral interval
What is the redudnant kjoint cpasuel attached on top th esynovial reces fo hte tibial called
capuselar refleciotmn
What isthe name of hte arhroscopic procedure inwhich one resects heyertrophic synovia tissue? What cuttinginstrument is used to remove this tissue?
synovectomy; shaver or punch or suciton punch
What is the name of thearthroscopic procedufre in whic one debrides uneven or fibrillated carilagenou tissue form an ankle joint?
chnondroplasty
Does a properly performed chondropaslty initiate carilage repair? why o rwhy not?
no veaue chondro;sty only somoothes out the fibrillated or unevne portions of caritlage nad noes onto revscualrize the actual defect