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70 Cards in this Set
- Front
- Back
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scope portals should be separated as much as possible (consistent with anatomy) to prevent..
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skin necrosis
- at least 1 cm apart |
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if an instrument breaks with in the joint during scope, what should be done
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-shut off the outflow, keep inflow on to keep joint distended for retrieval of broken piece
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what structures are considered with AL scope portal
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between the EDL and SPN
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when is a transmalleolar approach for talar lesions contraindicated
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-kids with open epiphyses
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what structures are considered with AM scope portal
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between the saphenous vein and TA tendon
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what is the MC size and angulation of scope in the ankle
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2.7 mm and 30 degrees
-or 0 degrees of angulation |
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how would you confirm that the loose body seen on xray is intra-articular instead of intra-capsular or extra-articular
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-perform an arthrogram
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anterior soft tissue impingement of the ankle is usually limited to what area
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-syndesmosis and lateral gutter
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what structures are considered with PL scope portal
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sural and short saphenous vein
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transmalleolar portals are more often required on which side of the ankle joint and why
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-on the medial side
-bc lateral dome lesions are more anterior than on the medial side -bc the lateral mall is furthur posterior then the med mall |
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3 basic techniques used in scoping
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-pistoning
-scanning -rotating |
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which scope portal is developed first
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-medial port (then the joint is surveryed before placing lateral port)
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contraindications for skeletal distraction in scoping
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-infections
-osteopenia -open epiphysis -lax ligaments |
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indications for use of single heavy pin distraction in scoping
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(3/16)
-large bone structure in males -long cases -difficult pathology -tight ankles -ankel arthrodesis |
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advantages for use of double pin (7/64) distraction
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-better control
-less chance of stress riser then 3/16 -less chance of pin tract infection |
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what are the reccomended parameters of force and duration for non-invasive distraction during scoping
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20 lbs of force for 30-45 minutes
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what are the parameters for proximal pin placement in skeletal displacemnt
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-2-4 inches above the ankle joint from the lateral side
-inserted 2 inches |
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list 3 methods of distraction for ankle scoping
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-non invasive
-manual distraction (gravity) -invasive; skeletal pin distraction |
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what are the parameters for distal pin placement in skeletal displacement
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2 in calc
1 in talus |
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when using 3/16 invasive distraction; how long should the patient avoid athletic acitivty and heavy work.
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8-10 weeks to decrease the risk of fracture
(4-6 weeks with 7/64 pin) |
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what type of synovitis occurs in 3 stages
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chronic synovial chondromatosis (proliferation of synovium into bone forming cartilage)
-synovium forms cartilage, it breaks off in the joint, is fed by synovial fluid; enlarges and ossifies |
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PVNS
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Pigmented villonodular synovitis
-synovitis with advanced papillary formation and hemosideran cells present |
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MC area for talar dome lesion
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medial (PI)
-deep, cup shaped |
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clinical signs of medial OCD
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-tenderness behind the medial mall with AJ in DF
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clincial symptoms of lateral OCD
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pain in AJ, when ankle is max PF
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what size wire is used for drilling of OCD
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0.062 K wire
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how should a bone graft be placed in the articular cartilage of an OCD
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1-2 mm below the level of the articular cartilage
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what dye can be used to view OCD's
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methylene blue dye can be injected into the joint nad hten washed out with irrigant saline
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what technique is used in arthroscopic ankle arthrodesis
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-arthroscopic transmalleolar cross screw fixation
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what is a disadvantage of ankle scope
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difficult to correct severe valgus/varus malalignment
-varus/valgus greater then 15 degree is a CONTRAINDICATION for ankle scope |
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type and size of screws for ankle scope fusion
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6.5 mm cancellous cannulated
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abnormal values for anterior drawer stress test
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5-10 mm of anterior displacement of the talus on the distal tibia
(>5 mm contralateral) |
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according to R.W. Jackson (1982); how does ankle scoping relieve symptoms
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-21% relief of symptoms from joint lavage
-4% relief of symptoms from actual lysis of adhesions |
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describe Berndt Hardy classification (transchondral fractures)
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1. compression of articular cartilage
2. incomplete fracture 3. non displaced complete fracture 4. displaced complete fracture |
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how is a scope sterilized
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First case: ethylene oxide gas
Subsequent cases: glutaraldehyde solution for 20 minutes (scopes cant be autoclaved) |
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probable dx if you can only inject 10-12 mL of saline into the joint
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capsular adhesions or fibrosis
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name the indications for ankle joint scope (12)
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-chronic ankle instability
-peristant AJ pain -ankle fractures -ankle fusions -arthritis -adhesive capsulitis -synovitis -meniscoid bodies -chondromalcia -OCD -anterior impingement exostosis -pre op planning |
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with a larger degree of tip cut, what happens to the field
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larger degree of tip cut, the wider the field
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first sucessful joint scope
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Takagi - U of Tokyo 1918 (of the knee)
-he also performed the first ankle scope in 1939 |
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scope instrument with sharp point, used to pierce soft tissue and capsule
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trocar
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scope instrument with blunt point and used to enter a joint
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obturator; prevents iatrogenic cartilage damage
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scopes are available in what sizes
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1.7 mm - 8.0 mm
use 2.7 mm for ankles |
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for chondromalacia, OCD, OA; burrs are used to abrade articular cartilage to what level
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bleeding bone
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Ant-medial port goes medial to what structure
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TA tendon
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ant-central port is located lateral to what structure
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EHL
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what nerves are at risk of being injured with the 5 diff portals
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PM: post tibial nerve
PL:sural nerve AM:saphenous nerve AL:terminal branches of SPN AC:DPN |
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three types of light sources used in a scope
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-xenon
-quartz halogen -incadescent |
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are the flutes in the sphere of an abrader more agressive in cutting in the forward or reverse direction
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forward
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how does the speed of rotations of its blades affect a shaver
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the slower the shaver rotates, the more agressive the cuts
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how does speed of the abrader affect the cutting
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the faster it moves, the more aggressive it cuts
- slower shavers , more agressive |
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what xray view is used for anterior drawer test
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lateral
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how many degrees of varus tilt are needed before inversion stress test is considered abnormal
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>10 degrees compared to contralateral
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whay xray view is used for inversion stress test
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AP
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what color is normal synovial fluid? inflammatory synovial fluid? gout synovial fluid?
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normal; clear, light pale yellow
inflammatory: turbid gout or RA; milky |
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abrasion arhtroplasty resects necrotic islands of cartilage and/or subchondral bone to what depth and why
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-to the level of the tidemark below the subchondral bone
-bc this is the area that supplies the vascularity to provide nutrition and growth to new healthy hyaline cartilage -tide mark: marks the border between calcified and uncalcified cartilage |
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egress portal
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portal that allows for flushing and rinsing of a joint
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soft tissue pathology that involves hypertrophy of normal anatomic structures secondary to the inflamm process
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impingement syndrome
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ligaments, joint capsules, synovial membranes: which does not have a rich supply of nerves
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synovial membrane
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describe how acute synoviits appears
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-long transparent hypertrophic villi of uniform length with a enlarged central vessel that has ruptured (hemorhagic hypertrophic synovitis)
(HYPERTROPHY, LONG, UNIFORM) |
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describe how chronic synovitis appears
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-frayed, opaque villi of different lengths secondary to necrosis of their tips
(OPAQUE, VARIED LENGTH) |
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medial bend is the part of the anatomy of what bone
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tibia
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depression in the talar surface that runs from AC to PC
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sagittal groove
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anterior tibial lip is composed of what
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hyaline cartilage
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name the procedure: resecting the hypertrophic synovial tissue with a scope; what instrument is used
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synovectomy
-use a shaver, punch or suction punch |
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name the procedure: scope debrides uneven or fibrillated cartlagenous tissue from AJ
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chondroplasty
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does a condroplasty initiate cartilage repair
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no, it only smooths out the fibrillated or uneven portions of cartilage
-it does not revascularize the actual defect |
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contraindications to ankle scope
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-DJD
-edema -infection -poor vascularity |
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dark sanquinous fluid is aspirated from the joint
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PVNS
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post op NWB for soft tissue scope procedure? for bone procedure?
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ST: 3 wks NWB
Bone: 6-8 wks NWB |
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how does anterior soft tissue impingement occur
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-ligament damage can allow the talus to extrude anteriorly and cause impingement of ST on DF
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